Skip to main content
Top
Published in: Cardiovascular Ultrasound 1/2015

Open Access 01-12-2015 | Research

Relation between E/e’ ratio and NT-proBNP levels in elderly patients with symptomatic severe aortic stenosis

Authors: Mihai Strachinaru, Bas M. van Dalen, Nicolas Van Mieghem, Peter P. T. De Jaegere, Tjebbe W. Galema, Marielle Morissens, Marcel L. Geleijnse

Published in: Cardiovascular Ultrasound | Issue 1/2015

Login to get access

Abstract

Background

Symptoms in the elderly patients with severe aortic stenosis (AS) and co-morbidities seem to lack in specificity. Therefore, objective parameters for increased left ventricular(LV) filling pressures are needed. The aim of this study was to investigate the correlation between the septal, lateral and average E/e’ ratio and the value of the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP).

Methods

Two-hundred-fifty consecutive symptomatic patients (mean age 80 ± 8 years, 52 % men) with severe AS underwent transthoracic echocardiography and NT-proBNP measurement.

Results

In the overall population the septal E/e’ (r = 0,459, r2 = 0,21, P <0,0001), lateral E/e’ (r = 0,322, r2 = 0,10, P <0,0001), and the average E/e’ (r = 0,432, r2 = 0,18, P <0,0001) were all significantly correlated to NT-proBNP. After the exclusion of patients with confounders (more than mild aortic or mitral regurgitation, severe renal dysfunction, obesity or severe COPD) the septal E/e’ (r = 0,584, r2 = 0,34, P <0,0001), lateral E/e’ (r = 0,377, r2 = 0,14, P <0,0001), and the average E/e’ (r = 0,487, r2 = 0,24, P <0,0001) were all significantly better correlated to NT-proBNP. In obese patients no significant correlations were seen. Previous bypass surgery did not alter the correlations.

Conclusions

In elderly patients with severe symptomatic AS there is a significant correlation between the E/e’ ratio and NT-proBNP, in particular after exclusion of confounders. The correlation was best for the septal E/e’ ratio and was preserved in patients with a history of bypass surgery.
Literature
1.
go back to reference Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Ba¨rwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43.CrossRefPubMed Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Ba¨rwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43.CrossRefPubMed
2.
go back to reference Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;63:e57–185. doi:10.1016/j.jacc.2014.02.536.CrossRefPubMed Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;63:e57–185. doi:10.​1016/​j.​jacc.​2014.​02.​536.CrossRefPubMed
5.
go back to reference D’Agate DJ, Smith RH, Lazar JM. Doppler echocardiographic assessment of left ventricular filling pressures in elderly patients with moderate/severe aortic stenosis. Am J Geriatr Cardiol. 2002;11:173–6.CrossRefPubMed D’Agate DJ, Smith RH, Lazar JM. Doppler echocardiographic assessment of left ventricular filling pressures in elderly patients with moderate/severe aortic stenosis. Am J Geriatr Cardiol. 2002;11:173–6.CrossRefPubMed
6.
go back to reference Gjertsson P, Caidahl K, Farasati M, Odén A, Bech-Hanssen O. Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis. J Thorac Cardiovasc Surg. 2005;129:890–6.CrossRefPubMed Gjertsson P, Caidahl K, Farasati M, Odén A, Bech-Hanssen O. Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis. J Thorac Cardiovasc Surg. 2005;129:890–6.CrossRefPubMed
7.
go back to reference McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines, ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14:803–69. doi: 10.1093/eurjhf/hfs105.CrossRefPubMed McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Committee for Practice Guidelines, ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14:803–69. doi: 10.1093/eurjhf/hfs105.CrossRefPubMed
10.
go back to reference Nessmith MG, Fukuta H, Brucks S, Little WC. Usefulness of an elevated B-type natriuretic peptide in predicting survival in patients with aortic stenosis treated without surgery. Am J Cardiol. 2005;96:1445–8.CrossRefPubMed Nessmith MG, Fukuta H, Brucks S, Little WC. Usefulness of an elevated B-type natriuretic peptide in predicting survival in patients with aortic stenosis treated without surgery. Am J Cardiol. 2005;96:1445–8.CrossRefPubMed
11.
go back to reference Pedrazzini GB, Masson S, Latini R, Klersy C, Rossi MG, Pasotti E, et al. Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol. 2008;102:749–54. doi:10.1016/j.amjcard.2008.04.055.CrossRefPubMed Pedrazzini GB, Masson S, Latini R, Klersy C, Rossi MG, Pasotti E, et al. Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol. 2008;102:749–54. doi:10.​1016/​j.​amjcard.​2008.​04.​055.CrossRefPubMed
12.
go back to reference Ben-Dor I, Minha S, Barbash IM, Aly O, Dvir D, Deksissa T, et al. Correlation of brain natriuretic peptide levels in patients with severe aortic stenosis undergoing operative valve replacement or percutaneous transcatheter intervention with clinical, echocardiographic, and hemodynamic factors and prognosis. Am J Cardiol. 2013;112:574–9. doi:10.1016/j.amjcard.2013.04.023.CrossRefPubMed Ben-Dor I, Minha S, Barbash IM, Aly O, Dvir D, Deksissa T, et al. Correlation of brain natriuretic peptide levels in patients with severe aortic stenosis undergoing operative valve replacement or percutaneous transcatheter intervention with clinical, echocardiographic, and hemodynamic factors and prognosis. Am J Cardiol. 2013;112:574–9. doi:10.​1016/​j.​amjcard.​2013.​04.​023.CrossRefPubMed
14.
go back to reference Bergler-Klein J, Klaar U, Heger M, Rosenhek R, Mundigler G, Gabriel H, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation. 2004;109:2302–8.CrossRefPubMed Bergler-Klein J, Klaar U, Heger M, Rosenhek R, Mundigler G, Gabriel H, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation. 2004;109:2302–8.CrossRefPubMed
15.
go back to reference Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T. Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J. 2004;148:696–702.CrossRefPubMed Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T. Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J. 2004;148:696–702.CrossRefPubMed
16.
go back to reference Galema TW, Yap SC, Geleijnse ML, van Thiel RJ, Lindemans J, ten Cate FJ, et al. Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro-B-type natriuretic peptide in patients with symptomatic severe aortic stenosis. J Am Soc Echocardiogr. 2008;21:257–61.CrossRefPubMed Galema TW, Yap SC, Geleijnse ML, van Thiel RJ, Lindemans J, ten Cate FJ, et al. Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro-B-type natriuretic peptide in patients with symptomatic severe aortic stenosis. J Am Soc Echocardiogr. 2008;21:257–61.CrossRefPubMed
17.
go back to reference Adeera Levin, Paul E, Stevens. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2013;49–61; doi:10.1038/ki.2013.444 Adeera Levin, Paul E, Stevens. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2013;49–61; doi:10.1038/ki.2013.444
18.
go back to reference WHO. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000. WHO. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.
20.
go back to reference Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96. doi: 10.1093/eurheartj/ehs109.CrossRef Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96. doi: 10.1093/eurheartj/ehs109.CrossRef
21.
go back to reference Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–94.CrossRefPubMed Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–94.CrossRefPubMed
22.
go back to reference Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33. doi: 1016/j.echo.2008.11.023.CrossRefPubMed Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22:107–33. doi: 1016/j.echo.2008.11.023.CrossRefPubMed
23.
go back to reference Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.CrossRefPubMed Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.CrossRefPubMed
24.
go back to reference Firstenberg MS, Levine BD, Garcia MJ, Greenberg NL, Cardon L, Morehead AJ, et al. Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol. 2000;36:1664–9.CrossRefPubMed Firstenberg MS, Levine BD, Garcia MJ, Greenberg NL, Cardon L, Morehead AJ, et al. Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol. 2000;36:1664–9.CrossRefPubMed
25.
go back to reference Srivastava PM, Burrell LM, Calafiore P. Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use? Eur J Echocardiogr. 2005;6:97–106.CrossRefPubMed Srivastava PM, Burrell LM, Calafiore P. Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use? Eur J Echocardiogr. 2005;6:97–106.CrossRefPubMed
26.
go back to reference Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–33.CrossRefPubMed Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–33.CrossRefPubMed
27.
go back to reference Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quiñones MA, Zoghbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation. 1998;98:1644–50.CrossRefPubMed Nagueh SF, Mikati I, Kopelen HA, Middleton KJ, Quiñones MA, Zoghbi WA. Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation. 1998;98:1644–50.CrossRefPubMed
28.
go back to reference Tsang W, Meineri M, Hahn RT, Veronesi F, Shah AP, Osten M, et al. A three-dimensional echocardiographic study on aortic–mitral coupling in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging. 2013; doi: 10.1093/ehjci/jet058 Tsang W, Meineri M, Hahn RT, Veronesi F, Shah AP, Osten M, et al. A three-dimensional echocardiographic study on aortic–mitral coupling in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging. 2013; doi: 10.1093/ehjci/jet058
29.
go back to reference Codreanu I, Pegg TJ, Selvanayagam JB, Robson MD, Rider OJ, Dasanu CA, et al. Details of left ventricular remodeling and the mechanism of paradoxical ventricular septal motion after coronary artery bypass graft surgery. J Invasive Cardiol. 2011;23:276–82.PubMed Codreanu I, Pegg TJ, Selvanayagam JB, Robson MD, Rider OJ, Dasanu CA, et al. Details of left ventricular remodeling and the mechanism of paradoxical ventricular septal motion after coronary artery bypass graft surgery. J Invasive Cardiol. 2011;23:276–82.PubMed
31.
go back to reference Watanabe T, Iwai-Takano M, Oikawa M, Yamaki T, Yaoita H, Maruyama Y. Optimal noninvasive assessment of diastolic heart failure in patients with atrial fibrillation: comparison of tissue doppler echocardiography, left atrium size, and brain natriuretic peptide. J Am Soc Echocardiogr. 2008;21:689–96.CrossRefPubMed Watanabe T, Iwai-Takano M, Oikawa M, Yamaki T, Yaoita H, Maruyama Y. Optimal noninvasive assessment of diastolic heart failure in patients with atrial fibrillation: comparison of tissue doppler echocardiography, left atrium size, and brain natriuretic peptide. J Am Soc Echocardiogr. 2008;21:689–96.CrossRefPubMed
32.
go back to reference Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue Doppler imaging recordings. Am Heart J. 2004;148:895–902.CrossRefPubMed Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue Doppler imaging recordings. Am Heart J. 2004;148:895–902.CrossRefPubMed
33.
go back to reference Eindhoven JA, van den Bosch AE, Ruys TP, Opić P, Cuypers JA, McGhie JS, et al. N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol. 2013;62:1203–12. doi:10.1016/j.jacc.2013.07.019.CrossRefPubMed Eindhoven JA, van den Bosch AE, Ruys TP, Opić P, Cuypers JA, McGhie JS, et al. N-terminal pro-B-type natriuretic peptide and its relationship with cardiac function in adults with congenital heart disease. J Am Coll Cardiol. 2013;62:1203–12. doi:10.​1016/​j.​jacc.​2013.​07.​019.CrossRefPubMed
34.
go back to reference Cemri M, Arslan U, Kocaman SA, Cengel A. Relationship between N-terminal pro-B type natriuretic peptide and extensive echocardiographic parameters in mild to moderate aortic stenosis. J Postgrad Med. 2008;54:12–6.CrossRefPubMed Cemri M, Arslan U, Kocaman SA, Cengel A. Relationship between N-terminal pro-B type natriuretic peptide and extensive echocardiographic parameters in mild to moderate aortic stenosis. J Postgrad Med. 2008;54:12–6.CrossRefPubMed
35.
go back to reference Galderisi M, Lancellotti P, Donal E, Cardim N, Edvardsen T, Habib G, et al. European multicentre validation study of the accuracy of E/e’ ratio in estimating invasive left ventricular filling pressure: EURO-FILLING study. Eur Heart J Cardiovasc Imaging. 2014;15:810–6. doi:10.1093/ehjci/jeu022.CrossRefPubMed Galderisi M, Lancellotti P, Donal E, Cardim N, Edvardsen T, Habib G, et al. European multicentre validation study of the accuracy of E/e’ ratio in estimating invasive left ventricular filling pressure: EURO-FILLING study. Eur Heart J Cardiovasc Imaging. 2014;15:810–6. doi:10.​1093/​ehjci/​jeu022.CrossRefPubMed
36.
go back to reference Beleigoli A, Diniz M, Nunes M, Barbosa M, Fernandes S, Abreu M, et al. Reduced brain natriuretic peptide levels in class III obesity: the role of metabolic and cardiovascular factors. Obes Facts. 2011;4:427–32.CrossRefPubMed Beleigoli A, Diniz M, Nunes M, Barbosa M, Fernandes S, Abreu M, et al. Reduced brain natriuretic peptide levels in class III obesity: the role of metabolic and cardiovascular factors. Obes Facts. 2011;4:427–32.CrossRefPubMed
Metadata
Title
Relation between E/e’ ratio and NT-proBNP levels in elderly patients with symptomatic severe aortic stenosis
Authors
Mihai Strachinaru
Bas M. van Dalen
Nicolas Van Mieghem
Peter P. T. De Jaegere
Tjebbe W. Galema
Marielle Morissens
Marcel L. Geleijnse
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2015
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-015-0021-8

Other articles of this Issue 1/2015

Cardiovascular Ultrasound 1/2015 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.