N-terminal proBNP levels in patients with Chagas disease: A marker of systolic and diastolic dysfunction of the left ventricle

doi:10.1016/j.euje.2006.03.011

European Journal of Echocardiography 2007 8(3):204-212; doi:10.1016/j.euje.2006.03.011

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N-terminal proBNP levels in patients with Chagas disease: A marker of systolic and diastolic dysfunction of the left ventricle

Marcia M. Barbosa^a, Maria do Carmo P. Nunes^a^,b^,*, Antônio Luiz P. Ribeiro^b, Marselha M. Barral^a^,b and Manoel Otávio C. Rocha^b

^aEcocenter, Hospital Socor, Av. Contorno 10500, 30110-140 Belo Horizonte, MG, Brazil
^bPostgraduate Course of Tropical Medicine, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Av. Alfredo Balena 190, Campus Saúde, 30130-100 Belo Horizonte, MG, Brazil

Received 5 November 2005; received in revised form 8 March 2006; accepted after revision 19 March 2006.

^* Corresponding author. R. Ludgero Dolabela, 801, 601, 30430-130 Belo Horizonte, MG, Brazil. Tel.: +55 31 3337 5442; fax: +55 31 3286 1393. mcarmo{at}waymail.com.br

Abstract

Aims NT-proBNP levels are known to be elevated in systolic anddiastolic dysfunction. Doppler indices of diastolic dysfunction(DD) have been shown to have prognostic value in patients withChagas' cardiomyopathy (CC). However, the additional value ofNT-proBNP levels in further stratifying these patients accordingto DD has not been established. This study analyzed the correlationof N-terminal proBNP (NT-proBNP) levels with systolic and diastolicfunction in patients with CC.

Methods and results NT-proBNP levels were measured in 59 patientswith dilated cardiomyopathy due to Chagas disease without othersystemic illness that were studied by Doppler echocardiography,including left atrial volume (LAV) calculation and tissue Dopplerevaluation of LV longitudinal function.

Univariate analysis showed a strong correlation of NT-proBNPvalues with LVEF (r=–0.733, p<0.001) and a weak correlationwith most Doppler echocardiographic parameters of diastolicfunction. On a multivariate analysis, LVEF and LAV volume emergedas correlating with elevated levels of the NT-proBNP. Patientswith restrictive filling pattern (n=10), when compared to otherpatterns of DD, (n=49), showed a lower LVEF (25.4±6.4%vs. 39.8±9.4, p<0.001), a larger LAV (50.1±17.2vs. 37.7±15.6ml/m², p=0.004) and higher NT-proBNP levels(median±IQR: 3488±3056 vs. 492±700pg/dl,p<0.001). A marked elevated concentration of NT-proBNP ( $≥$ 800pg/ml)had a sensitivity of 90.0%, specificity of 70.5%, positive predictivevalue of 40.9% and negative predictive value of 96.9% for detectinga restrictive filling pattern.

Conclusion In patients with CC, NT-proBNP augmentation is amarker of LV dysfunction, with higher levels correlating withthe more severe forms of both systolic and diastolic dysfunction.

Keywords: Chagas disease; NT-proBNP; Heart failure; Doppler echocardiography

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