Correlation between brain natriuretic peptide levels and the prognosis of patients with left ventricular diastolic dysfunction

B-type Natriuretic Peptide: A Diagnostic Biomarker for a Hemodynamically Significant PDA

Background: B-type natriuretic peptide (BNP) it has been reported to be a useful biomarker for the severity of hemodynamically significant patent ductus arteriosus (HsPDA) in premature infants. Objective: To assess serum levels of BNP in premature neonates with echocardiographically-confirmed hemodynamically significant and non-significant PDA (HnsPDA) and to explore the effect of PDA on left ventricular function. We also aimed to detect the level of BNP that differentiates between HsPDA and HnsPDA. Patients and methods: This was a cross-sectional observational study conducted on 73 randomly selected preterm neonates with HsPDA or hemodynamically nonsignificant PDA (HnsPDA), between May 2017 and May 2018. Echocardiography was done. BNP was measured using enzyme linked immunosorbent assay Results: There was no affection of left ventricular function in either group (LA/Ao ratio, FS, LVESD and LVEDD). PDA size, PFO size and PAP were significantly larger in HsPDA (p<0.001, p=0.001, p<0.001 respectively). Levels of BNP were significantly higher in HsPDA and correlated with the size of the PDA. At a cut-off value of 160.5 pg/ml, BNP had 80.49% sensitivity and 90.62% specificity with a positive predictive value of 91.7% and a negative predictive value of 78.04%, (AUC: 0.923, 95% C.I. 0.837 to 0.973). Conclusion: Levels of BNP in preterm babies with hemodynamically significant PDA rise early in neonatal life and correlate well with the size of the PDA. BNP can be used to screen for this condition. Ventricular dysfunction may not appear in the first 3 days of life.

Diastolic dysfunction in hypertension

Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction.