[Asymptomatic ischemic heart dysfunction, echocardiographic changes and NT-proBNP during 2-years observation]

Agnieszka Skrzypek, Jadwiga Nessler
Przegla̧d Lekarski 2014, 71 (7): 378-83

BACKGROUND: Asymptomatic systolic dysfunction of the left ventricle (LV) refers to patients without current clinical symptoms of heart failure.

AIM: 1. Analysis of echocardiographic parameters in patients with stable angina pectoris without symptoms of heart failure and their changes in two years time 2. Determine the importance of NT-proBNP for early detection of asymptomatic heart dysfunction in patients with stable angina pectoris and its influence on the prognosis in two years 3. Analysis of the relationship between the degree of the left ventricular diastolic dysfunction and co-morbidities and selected echocardiographic parameters 4. Significance of prognostic selected echocardiographic parameters (E/ Vp, E/E', Ar) in patients with stable angina pectoris without any symptoms of heart failure.

PATIENTS: The study included 57 patients with stable ischemic heart disease, no history of myocardial infarction: including 35 men (61.4%) aged 35-56 years (mean 51.08 +/- 4.01 years) hospitalized in the Department of Coronary Artery Disease, Institute of Cardiology, Jagiellonian University in Krakow. Analysis after two years involved 56 patients (1 patient died after a year of observation).

METHODS: Patients were evaluated 2x: before and after 2 years (assessment of clinical status: physical examination, the severity of angina and physical examination, atherosclerotic risk factors, ECG, lipid profile, plasma NT-proBNP). Patients were divided into three groups: Group A, patients with LV normal function (32 patients), Group B - with impaired diastolic function (22), Group C - with impaired systolic and diastolic function (EF < or = 50%, as measured by Simpson; 3 patients).

RESULTS: Subgroups of respondents ABC did not differ significantly with respect to age, sex and risk fac- tors of atherosclerosis. There was a significant correlation between the type of LV dysfunction and indicators of elevated end diastolic pressure in LV: E/Vp (p = 0.0002), E/E' (p = 0.0006), Ar (p = 0.034) and the propagation velocity Vp (0 = 0.001). There was a significant correlation between systolic and diastolic heart dysfunction and the levels of NT-proBNP (p = 0.018). After 2 years, patients with deterioration of heart function in group A noticed a significant correlation between occurrence of diastolic dysfunction and presence of diabetes mellitus type II (p = 0.01). Conclusions: 1. Elevated levels of NT-proBNP indicates the impairment of systolic andlor diastolic asymptomatic patients. NT-proBNP is therefore important for early detection of asymptomatic cardiac dysfunction in patients with stable angina pectoris. 2. In patients with stable angina pectoris without symptoms of heart failure: the value of E/Vp > or = 1.5 and E/E '> or = 8 can be the marker of more advanced coronary atherosclerosis, manifested by three-vessel disease or stenosis of the left main coronary artery.

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