Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study.

Abstract

BACKGROUND:

When heart failure and tachycardia occur simultaneously, a useful diagnostic tool for early discrimination of patients with benign tachycardia-mediated cardiomyopathy (TMC) versus major structural heart disease (MSHD) is not available. Such a tool is required to prevent unnecessary and wearing diagnostics in patients with reversible TMC. Moreover, it could lead to early additional diagnostics and therapeutic approaches in patients with MSHD.

METHODS:

A total of 387 consecutive patients with supraventricular arrhythmia underwent assessment at a single center. Of these patients, 40 fulfilled the inclusion criteria with a resting heart rate ≥100 bpm and an impaired left ventricular ejection fraction <40%. In all patients, successful electrical cardioversion was performed. At baseline, day 1 and weekly for 4 weeks, levels of NT-proBNP and echocardiographic parameters were evaluated. An NT-proBNP ratio (BNP-R) was calculated as a quotient of baseline NT-proBNP/follow-up NT-proBNP. After 4 weeks, cardiac catheterization was performed to identify patients with a final diagnosis of TMC versus MSHD.

RESULTS:

Initial NT-proBNP concentrations were elevated and consecutively decreased after cardioversion in all patients. Multivariate regression and ROC analysis revealed that BNP-R discriminated between patients with TMC versus MSHD independent and superior to all other variables. The area under the ROC curve for BNP-R to detect TMC was 0.90 (95% CI 0.79-1.00; p < 0.001) after 1 week and 0.995 (95% CI 0.99-1.00; p < 0.0001) after 4 weeks. One week after cardioversion already, a BNP-R cutoff ≥2.3 was useful for TMC diagnosis indicated by an accuracy of 90%, sensitivity of 84% and specificity of 95%.

CONCLUSION:

BNP-R was found to be highly accurate for the early diagnosis of TMC.

• Authors: Amir M Nia, Natig Gassanov, Kristina M Dahlem, Evren Caglayan, Martin Hellmich, Erland Erdmann, Fikret Er
• Journal: Clinical research in cardiology : official journal of the German Cardiac Society (Clin Res Cardiol) Vol. 100 Issue 10 Pg. 887-96 (Oct 2011) ISSN: 1861-0692 [Electronic] Germany
• PMID: 21538234 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Biomarkers
• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Aged
• Biomarkers (blood)
• Cardiac Catheterization
• Cardiomyopathies (blood, diagnosis, etiology, physiopathology, therapy)
• Early Diagnosis
• Echocardiography, Doppler
• Electric Countershock
• Exercise Test
• Female
• Germany
• Heart Failure (blood, diagnosis, etiology, physiopathology, therapy)
• Heart Rate
• Humans
• Logistic Models
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Pilot Projects
• Predictive Value of Tests
• ROC Curve
• Recovery of Function
• Stroke Volume
• Tachycardia, Supraventricular (blood, complications, diagnosis, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• Ventricular Function, Left