NT-pro BNP versus E/E’ Ratio after ECG Treadmill Test in Asymptomatic Hypertensive Patients with Exercise-Induced Diastolic Dysfunction

Nicolae Paun; Gabriela Uscoiu; Andreea Hodorogea; Irina Mariella Andrei; Camelia Nicolae; Tiberiu Ioan Nanea

doi:10.47803/rjc.2021.31.2.343

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NT-pro BNP versus E/E’ Ratio after ECG Treadmill Test in Asymptomatic Hypertensive Patients with Exercise-Induced Diastolic Dysfunction

Romanian Journal of Cardiology

Volume 31 (2021): Issue 2 (June 2021)

By: Nicolae Paun, Gabriela Uscoiu, Andreea Hodorogea, Irina Mariella Andrei, Camelia Nicolae and Tiberiu Ioan Nanea

Open Access

|May 2022

Abstract

Left ventricle dysfunction is the link between the heart morphological changes and the overt heart failure. Hypertension is one of the main cardio-vascular conditions which can lead to development of left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It intended to compare NT-pro BNP and the ratio E/E’ as markers of diastolic dysfunction in hypertensive patients and normal ejection fraction (EF) and no signs or symptoms of heart failure. Both indexes proved to reflect independently diastolic dysfunction in symptomatic patients with different cardiac diseases but not in asymptomatic hypertensive patients. It was a single-center observational study recruiting 40 participants (20 F 52–70 age, and 20 M 56–67 age). Natriuretic peptides are widely accepted as biomarkers in heart failure with reduced ejection fraction. NT-pro BNP proved to be a very good means of diagnosing exercise-related left ventricular dysfunction (LVD) showing that it could unveil a subclinical LVD, especially in patient with myocardial remodeling. The main goal of this study was to compare the values of NT-pro BNP and E/E’. We have found no correlation between NT-pro BNP and E/E’, both pre-exercise and post-exercise, demonstrating that the later was not a reliable means of diagnosing LVD at effort in aymptomatic hypertensive patients.

References

Veeran Subramaniam, Gregory Y H Lip; “Hypertension to heart failure: a pathophysiological spectrum relating blood pressure, drug treatments and stroke”; Expert Rev Cardiovasc Ther. 2009 Jun;7(6):703–13.doi: 10.1586/erc.09.43
Open DOI Search in Google Scholar Back to article
Arun Kannan, Rajesh Janardhanan, “Hypertension as a risk factor for” Curr Hypertens Rep. 2014 Jul;16(7):447.doi: 10.1007/s11906-014-0447-7
Open DOI Search in Google Scholar Back to article
Fabian Knebel, Ingolf Schimke, Kathleen Pliet, Sebastian Schattke, Salim Martin, Adrian C Borges, Gert Baumann; “NT-pro BNP in acute heart failure: correlation with invasively measured. 2005 Jun;11(5 Suppl):S38–41. doi: 10.1016/j.cardfail.2005.04.012.
Open DOI Search in Google Scholar Back to article
Frederick A. Masoudi, MD, MSPH, FACC, FAHA reviewing Januzzi JL Jr et al. “Ëmpiric NT-pro BNP cut points for diagnosing acute heart failure”; J Am Coll Cardiol 2018 Mar 20 McCullough PA and Kluger AY. J Am Coll Cardiol 2018 Mar 20
Search in Google Scholar Back to article
Acute and chronic heart failure guidelines; ESC Clinical Practice Guidelines EHJ (2016) 37 (27):2129–2200
Open DOI Search in Google Scholar Back to article
Sherif F. Nagueh, Chair, MD, FASE,1 Otto A. Smiseth, Co-Chair, MD, PhD,2 Christopher P. Appleton, MD, Benjamin F. Byrd, III, MD, FASE, Hisham Dokainish, MD, FASE, Thor Edvardsen, MD, PhD, Frank A. Flachskampf, MD, PhD, FESC,2 Thierry C. Gillebert, MD, PhD, FESC, Allan L. Klein, MD, FASE,1 Patrizio Lancellotti, MD, PhD, FESC, Paolo Marino, MD, FESC,2 Jae K. Oh, MD, Bogdan Alexandru Popescu, MD, PhD, FESC, FASE, and Alan D. Waggoner, MHS, RDCS; “Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging”; J Am Soc Echocardiogr 2016;29:277–314
Open DOI Search in Google Scholar Back to article
Miguel Riveraa, Raquel Taléns-Viscontia, Antonio Salvadorb, Vicente Bertomeuc, Vicente Miród, Fernando García de Burgose, Vicente Climentf, Raquel Cortésa, Rafael Payág, José L Pérez-Boscág, Luis Mainarh, Alejandro Jordáne, Francisco Sogorbf, Juan Cosína, Vicente Morab, José L Diagoi, Francisco Marínf “NT-pro BNP levels and hypertension. Their importance in diagnosis of heart failure”; Rev Esp Cardiol. 2004 May; 57(5):396–402.
Search in Google Scholar Back to article
Kazumasa Marumoto, Mareomi Hamada, Masahito Aburaya, Kunio Hiwada: “Augmented Secretion of Atrial and Brain Natriuretic Peptides During dynamic Exercise in Patients With Old Myocardial Infarction”; Japanese Circulation Journal, 1995 Volume 59 Issue 11 Pages 715–724
Open DOI Search in Google Scholar Back to article
Ji-Won Hwang, Sung-Ji Park, Eun Jeong Cho, Eun Kyoung Kim, Ga Yeon Lee, Sung-A Chang, Jin-Oh Choi, Sang-Chol Lee, Seung Woo Park; “Relation of N-Terminal Pro-B-Type Natriuretic Peptide and Left Ventricular Diastolic Function to Exercise Tolerance in Patients With Significant Valvular Heart Disease and Normal Left Ventricular Systolic Function” Am J Cardiol. 2017 Jun 1;119(11):1846–1853
Open DOI Search in Google Scholar Back to article
Piotr Podolec, Paweł Rubís, Lidia Tomkiewicz-Pajak, Grzegorz Kopeć, Wiesława Tracz; “Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure”; J Am Soc Echocardiogr. 2008 Jul; 21(7):834–40.
Open DOI Search in Google Scholar Back to article
A Matsumoto, Y Hirata, S Momomura, E Suzuki, I Yokoyama, M Sata, Y Ohtani, T Serizawa; “Effects of exercise on plasma level of brain natriuretic peptide in congestive heart failure with and without left ventricular dysfunction”; Am Heart J. 1995 Jan;129(1):139–45
Open DOI Search in Google Scholar Back to article
Sharon Remmelzwaal, Adriana J. van Ballegooijen, Linda J. Schoonmade, Elisa Dal Canto, M. Louis Handoko, Michiel T. H. M. Henkens, Vanessa van Empel, Stephane R. B. Heymans & Joline W. J. Beulens “Natriuretic peptides for the detection of diastolic dysfunction and heart failure with preserved ejection fraction—a systematic review and meta-analysis”; BMC Medicine, Published: 30 October 2020
Open DOI Search in Google Scholar Back to article
John T. Reeves, Bertron M. Groves, Allen Cymerman, John R Sutton, Peter D. Wagner, Darya Turkevich, Charles S. Houston; “Operation Everest II: Cardiac filling pressures during cycle exercise at sea level”; Respiration Physiology, Volume 80, Issues 2–3, May–June 1990, Pages 147–154
Open DOI Search in Google Scholar Back to article
Hamasaki H, “The effects of exercise on Natriuretic Peptides in individuals without heart failure”, Sports (Basel), June 2016
Open DOI Search in Google Scholar Back to article
Michael K Stickland, Robert C Welsh, Stewart R Petersen, John V Tyberg, William D Anderson, Richard L Jones, Dylan A Taylor, Marcel Bouffard, Mark J Haykowsky; “Does fitness level modulate the cardiovascular hemodynamic response to exercise?”; J Appl Physiol (1985) 2006 Jun;100(6):1895–901
Open DOI Search in Google Scholar Back to article
Deepak R Talreja, Rick A Nishimura, Jae K Oh “Ëstimmationof of Left Ventricle Filling Pressure with Exercise by Doppler Echocardiography in Patients with Normal Systolic Function: A Simulteneous Echocardiographic-Catheterization Study”; J Am Soc Echocardiogr. 2007 May;20(5):477–9.
Open DOI Search in Google Scholar Back to article
Carsten Tschöpe, Mario Kasner, Dirk Westermann, Regina Gaub, Wolfgang C Poller, Heinz-Peter Schultheiss; “The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements”; Eur Heart J; 2005 Nov;26(21):2277–84.
Open DOI Search in Google Scholar Back to article
Malcolm I Burgess 1, Carly Jenkins, James E Sharman, Thomas H Marwick; “Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise”; J Am Coll Cardiol, 2006 May 2;47(9):1891–900
Open DOI Search in Google Scholar Back to article
M Kohno 1, T Horio, K Yokokawa, K Akioka, M Ikeda, T Takeda; “Pulmonary arterial brain natriuretic peptide concentration and cardiopulmonary hemodynamics during exercise in patients with essential hypertension” Metabolism, 1992 Dec;41(12):1273–5
Open DOI Search in Google Scholar Back to article
Carsten Tschöpe, Mario Kasner, Dirk Westermann, Thomas Walther, Regina Gaub, Wolfgang C Poller, Heinz-Peter Schultheiss; “Elevated NT-ProBNP levels in patients with increased left ventricular filling pressure during exercise despite preserved systolic function; J Card Fail; 2005 Jun;11(5 Suppl):S28–33.
Open DOI Search in Google Scholar Back to article
M Kohno, T Horio, K Yokokawa, K Akioka, M Ikeda, T Takeda; “Pulmonary arterial brain natriuretic peptide concentration and cardiopulmonary hemodynamics during exercise in patients with essential hypertension” Metabolism, 1992 Dec;41(12):1273–5
Open DOI Search in Google Scholar Back to article
N. Paun,, J.I. Sinelli,, conf. C. Nicolae, prof. T. I. Nanea, sef.lcr. C. Toader; “Exercise-induced NT-pro BNP secretion in hypertensive patients without heart failure can diagnose the subclinical left ventricle dysfunction”; Medicina Interna, April, 2021; in Press (manuscript accepted to be plublished in the 4th issue 2021)
Open DOI Search in Google Scholar Back to article
Gerald F. Fletcher, Philip A. Ades, Paul Kligfield, Ross Arena, Gary J. Balady, Vera A. Bittner, Lola A. Coke, Jerome L. Fleg, Daniel E. Forman, Thomas C. Gerber, Martha Gulat, Kushal Madan, Jonathan Rhodes, Paul D. Thompson and Mark A. Williams and on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention “Exercise standards for testing and training – A scientific statement from the American Heart Association”, Circulation, Volume 128, Issue 8, 20 August 2013, Pages 873–934
Open DOI Search in Google Scholar Back to article
Emmanuel Akintoye, Alexandros Briasoulis, Alexander Egbe, Shannon M Dunlay, Sudhir Kushwaha, Diane Levine Luis Afonso, Dariush Mozaffarian, Jarrett Weinberger “National trends in admission and In-hospital mortality of patients with heart failure in the United States (2001 – 2014)”; JAHA, 29 Nov 2017, vol. 6, nr. 12
Open DOI Search in Google Scholar Back to article
How to diagnose diastolic heart failure - European Study Group on Diastolic Heart Failure; Working group report; European Heart Journal (1998) 19, 990–1003
Open DOI Search in Google Scholar Back to article
Oleg F. Sharifov, MD, PhD; Himanshu Gupta, MD; “What Is the Evidence That the Tissue Doppler Index E/e0 Reflects Left Ventricular Filling Pressure Changes After Exercise or Pharmacological Intervention for Evaluating Diastolic Function? A Systematic Review”; J Am Heart Assoc. 2017;6:e004766. DOI: 10.1161/JAHA.116.004766
Open DOI Search in Google Scholar Back to article
Aliza Hussain, MD,a Wensheng Sun, MS,b,c Anita Deswal, MD, MPH,d James A. de Lemos, MD,e John W. McEvoy, MB BCH MHS,f Ron C. Hoogeveen, PHD,b,c Kunihiro Matsushita, MD, PHD,f David Aguilar, MD,g Biykem Bozkurt, MD, PHD,a,h Salim S. Virani, MD, PHD,a,b,h Amil M. Shah, MD, MPH,i Elizabeth Selvin, PHD, MPH,f Chiadi Ndumule, MD, PHD,f Christie M. Ballantyne, MD,a,b,c Vijay Nambi, MD, PHDa,b,c,h - “Association of NT-ProBNP, Blood Pressure, and Cardiovascular Events The ARIC Study”; JAAC, vol77, No 5, 2021
Search in Google Scholar Back to article
Shihui Fu Ping Ping Fengqi Wang and Leiming Luo; “Synthesis, secretion, function, metabolism ad application of natriuretic peptides in heart failure”, Journal of Biological Engineering volume 12, Article number: 2 (2018)
Open DOI Search in Google Scholar Back to article
Braunwald E, “Medical progress: Biomarkers in heart failure”, NEJM 2018; 358; 2148–2159
Open DOI Search in Google Scholar Back to article
A.G Fraser, N Payne, C.F Mädler, B Janerot-Sjøberg, B Lind, R.M Grocott-Mason, A.A Ionescu, N Florescu, U Wilkenshoff, P Lancellotti,, M Wütte, L-Å Brodin; “Feasibility and Reproducibility of Offline Tissue Doppler Measurement of Regional Myocardial Function During Dobutamine Stress Echocardiography”; European Journal of Echocardiography, Volume 4, Issue 1, March 2003, Pages 43–53,
Open DOI Search in Google Scholar Back to article
Dermot Phelan, Chris Watson, Ramon Martos, Patrick Collier, Anil Patle, Seamas Donnelly, Mark Ledwidge, John Baugh, Ken McDonald; “Modest Elevation in BNP in Asymptomatic Hypertensive Patients Reflects Sub-Clinical Cardiac Remodeling, Inflammation and Extra-cellular Matrix Changes”; PLOS ONE, November 2012 | Volume 7 | Issue 11 | e49259
Open DOI Search in Google Scholar Back to article
Olsen MH, Wachtell K, Tuxen C, Fossum E, Bang LE, Hall C, Ibsen H, Rokkedal J, Devereux RB, Hildebrandt PR “Opposite effects of losartan and atenolol on natriuretic peptides in patients with hypertension and left ventricular hypertrophy: a LIFE substudy. J Hypertens. 2005 May;23(5):1083–90. doi: 10.1097/01.hjh.0000166851.18463.85.
Open DOI Search in Google Scholar Back to article
Gyu Chul Oh & Hyun-Jai Cho “Blood pressure and heart failure”; Clinical Hypertension volume 26, Article number: 1 (2020)
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.47803/rjc.2021.31.2.343 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X

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Language: English, French, Romanian

Page range: 343 - 349

Published on: May 3, 2022

Published by: Romanian Society of Cardiology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

hypertension,

left ventricle ‘diastolic dysfunction,

Related subjects:

Surgery,

Pediatrics and juvenile medicine,

Paediatric cardiology

© 2022 Nicolae Paun, Gabriela Uscoiu, Andreea Hodorogea, Irina Mariella Andrei, Camelia Nicolae, Tiberiu Ioan Nanea, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 31 (2021): Issue 2 (June 2021)