DIASTOLIC DYSFUNCTION AND NATRIURETIC PEPTIDES IN SYSTOLIC HEART-FAILURE - HIGHER ANP AND BNP LEVELS ARE ASSOCIATED WITH THE RESTRICTIVE FILLING PATTERN

Background Left ventricular diastolic dysfunction is common in patient s with systolic heart failure and the restrictive type of filling patt ern appears to be associated with increased cardiac mortality. Both at rial and brain (or ventricular) natriuretic peptides are also proven m arkers of the severity of heart failure. The aim of this study was to determine in a large cohort of patients with systolic heart failure wh ether diastolic abnormalities, and in particular the restrictive filli ng pattern of transmitral flow velocity, correlate with plasma atrial and brain natriuretic peptide levels. Methods Sixty-eight consecutive patients with symptomatic systolic heart failure (ejection fraction <0 .5) underwent two-dimensional Doppler echocardiography of left ventric ular systolic and diastolic function, together with measurement of atr ial and brain natriuretic peptides. Results The restrictive filling pa ttern was present in 62%, the abnormal relaxation pattern in 31% and o nly 7% were normal. Atrial and brain natriuretic peptide (ANP/BNP) lev els were significantly higher in the restrictive compared to the abnor mal relaxation group (ANP: 202.2 +/- 31.7 vs 102.5 +/- 22.1 pg.ml(-1), P=0.012; BNP: 277.8 +/- 27.7 vs 162.4 +/- 21.9 pg.ml(-1), P=0.002). I n addition, a restrictive filling pattern was associated with lower ej ection fractions (P=0.026), higher pulmonary artery systolic pressure (P<0.001), larger left atrial size (P=0.044), and were more likely to be in New York Heart Association class III or IV than those with an ab normal relaxation pattern (P=0.007). Both atrial and brain natriuretic peptides correlated inversely with ejection fraction (P<0.001), fract ional shortening (P<0.001), and positively with pulmonary artery press ure (P=0.004 and 0.001 respectively). There were no significant correl ations between single diastolic parameters and atrial or brain natriur etic peptide levels for the total patient group except between mitral peak A wave velocity and brain natriuretic peptides (r=-03, P=0.01). F or those with abnormal relaxation pattern mitral, valve E-wave deceler ation time correlated significantly with both atrial and brain natriur etic peptide levels (P<0.01). Conclusions This study confirms that the restrictive filling pattern of transmitral flow velocity is a marker of more severe heart failure, as indicated by its association with hig her atrial and brain natriuretic peptide levels, lower ejection fracti on and higher pulmonary artery pressure. Thus, this easily obtained Do ppler-derived marker of diastolic dysfunction is useful for identifyin g those patients with more severe heart failure.