Isolated diastolic dysfunction - diagnostic value of tissue Doppler imaging, colour M-mode and N-terminal pro B-type natriuretic peptide

Introduction For diagnosis of diastolic dysfunction of the left ventricle (DDF), measurement of relaxation velocity (V-R) by tissue Doppler imaging (V-R), flow propagation velocity of transmitral inflow (v(p)) as well as the measurement of serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) compete with the standard echocardiographic DDF-measures because of several disadvantages of the latter. Methods We examined the diagnostic value of method 1, 2 and NT-proBNP in 120 patients with echocardiographic-proven DDF and in 20 patients without. Patients were classified according to the DDF-stage by standard echocardiographic parameters (transmitral E/A-ratio, deceleration time, isovolumetric relaxation time) into stage I, II and III and furthermore subdivided by the presence of dyspnoea. Results V-R and v(p) were significantly lower in patients with DDF than in patients without DDF, with no difference between the various DDF stages. Symptomatic patients showed a trend to a lower V-R. NT-proBNP was elevated in patients with DDF: Symptomatic patients with a DDF at stage I and patients with a DDF at stage II and III independent of the presence of symptoms had elevated NT-proBNP levels. Conclusion All three methods tested identified patients with DDF. NT-proBNP and v(p) were able to discriminate between symptomatic and asymptomatic patients.