| 박훈준, , 정해억, 최민석, 임민경, 길욱현, 박찬석, 김범준, 윤호중, 백상홍, 승기배, 김재형, 홍순조, 최규보 |
Background Recently, B-natriuretic peptide (BNP) level and Left atrial volume index (LAVi) were known to correlate with indices of LV diastolic function. Objective We compared the sensitivity and specificity between ANP, BNP and LAVi to predict the advanced diastolic dysfunction (grade II, III or IV) along with the systolic function. Methods 100 patients who referred for echocardiography were classified into two groups by ejection fraction (EF) of 50% (EF<50%, n=26 ; EF≥50%, n=74) and 4 diastolic function grade (grade 0, I, II, III or IV) by the doppler recording of the mitral inflow and tissue Doppler imaging of the mitral annuls. LAVi was measured by modified Simpson’s method in apical 4-chamber view at end-systole. BNP and ANP levels were measured on the same day as echocardiogram was done. Results If included in all patients, LAVi was increased with worsening DD: 24±7ml/m2 (grade 0), 27±9ml/m2 (grade I), 37±12ml/m2(grade II), 45±12ml/m2 (grade III or IV), p<0.001. BNP and ANP level were also increased as diastolic function grade was worsening ( BNP: 60±91, 109±205, 731±1005 and 1426±1421 pg/ml ; ANP: 22±30, 23±26, 89±91, 96±61 pg/ml, respectively. p<0.001). But all of these did not have statistical differences between grade 0 and I in post hoc test.. The area under the receiver-operator characteristic curve for BNP, ANP and LAVi to detect advanced diastolic dysfunction was 0.898, 0.858 and 0.833 respectively. . BNP of 108 pg/ml and ANP of 31 pg/ml had sensitivity of 85% and 81% and specificity of 80% and 81% respectively. LAVi of 30ml/ m2 had a sensitivity 80% and specificity 74% for predicting advanced diastolic dysfunction. In the group of EF<50%, there was no statistical difference in BNP level (p= 0.08) and LAVi (p=0.25) between diastolic dysfunction grade except ANP level (p=0.008). Conclusion These data suggest that BNP, ANP and LA volume index provided meaningful sensitivity and specificity for the detection of advanced diastolic dysfunction respectively. Interestingly, the screening power of ANP level to discriminate diastolic dysfunction is stronger than BNP level or LAVi in patients with systolic dysfunction
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