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Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study

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Abstract

Background

When heart failure and tachycardia occur simultaneously, a useful diagnostic tool for early discrimination of patients with benign tachycardia-mediated cardiomyopathy (TMC) versus major structural heart disease (MSHD) is not available. Such a tool is required to prevent unnecessary and wearing diagnostics in patients with reversible TMC. Moreover, it could lead to early additional diagnostics and therapeutic approaches in patients with MSHD.

Methods

A total of 387 consecutive patients with supraventricular arrhythmia underwent assessment at a single center. Of these patients, 40 fulfilled the inclusion criteria with a resting heart rate ≥100 bpm and an impaired left ventricular ejection fraction <40%. In all patients, successful electrical cardioversion was performed. At baseline, day 1 and weekly for 4 weeks, levels of NT-proBNP and echocardiographic parameters were evaluated. An NT-proBNP ratio (BNP-R) was calculated as a quotient of baseline NT-proBNP/follow-up NT-proBNP. After 4 weeks, cardiac catheterization was performed to identify patients with a final diagnosis of TMC versus MSHD.

Results

Initial NT-proBNP concentrations were elevated and consecutively decreased after cardioversion in all patients. Multivariate regression and ROC analysis revealed that BNP-R discriminated between patients with TMC versus MSHD independent and superior to all other variables. The area under the ROC curve for BNP-R to detect TMC was 0.90 (95% CI 0.79–1.00; p < 0.001) after 1 week and 0.995 (95% CI 0.99–1.00; p < 0.0001) after 4 weeks. One week after cardioversion already, a BNP-R cutoff ≥2.3 was useful for TMC diagnosis indicated by an accuracy of 90%, sensitivity of 84% and specificity of 95%.

Conclusion

BNP-R was found to be highly accurate for the early diagnosis of TMC.

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References

  1. Brignole M, Gianfranchi L, Menozzi C, Bottoni N, Bollini R, Lolli G, Oddone D, Gaggioli G (1994) Influence of atrioventricular junction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol 74(3):242–246. doi:0002-9149(94)90364-6[pii]

    Article  PubMed  CAS  Google Scholar 

  2. Grogan M, Smith HC, Gersh BJ, Wood DL (1992) Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 69(19):1570–1573

    Article  PubMed  CAS  Google Scholar 

  3. Rinaldi CA, Thompson DS (1999) Tachycardia-induced cardiomyopathy caused by atrial flutter responding to DC cardioversion. Hosp Med 60(4):305–306

    PubMed  CAS  Google Scholar 

  4. Cruz FE, Cheriex EC, Smeets JL, Atie J, Peres AK, Penn OC, Brugada P, Wellens HJ (1990) Reversibility of tachycardia-induced cardiomyopathy after cure of incessant supraventricular tachycardia. J Am Coll Cardiol 16(3):739–744. doi:0735-1097(90)90368-Y[pii]

    Article  PubMed  CAS  Google Scholar 

  5. Vijgen J, Hill P, Biblo LA, Carlson MD (1997) Tachycardia-induced cardiomyopathy secondary to right ventricular outflow tract ventricular tachycardia: improvement of left ventricular systolic function after radiofrequency catheter ablation of the arrhythmia. J Cardiovasc Electrophysiol 8(4):445–450

    Article  PubMed  CAS  Google Scholar 

  6. Link A, Reil JC, Selejan S, Bohm M (2009) Effect of ivabradine in dobutamine induced sinus tachycardia in a case of acute heart failure. Clin Res Cardiol 98(8):513–515. doi:10.1007/s00392-009-0038-9

    Article  PubMed  Google Scholar 

  7. Wilson JR, Douglas P, Hickey WF, Lanoce V, Ferraro N, Muhammad A, Reichek N (1987) Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation 75(4):857–867

    Article  PubMed  CAS  Google Scholar 

  8. Spinale FG, Holzgrefe HH, Mukherjee R, Arthur SR, Child MJ, Powell JR, Koster WH (1995) LV and myocyte structure and function after early recovery from tachycardia-induced cardiomyopathy. Am J Physiol 268(2 Pt 2):H836–H847

    PubMed  CAS  Google Scholar 

  9. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM (1997) Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29(4):709–715. doi:S073510979600592X[pii]

    Article  PubMed  CAS  Google Scholar 

  10. Yamamoto K, Burnett JC Jr, Meyer LM, Sinclair L, Stevens TL, Redfield MM (1996) Ventricular remodeling during development and recovery from modified tachycardia-induced cardiomyopathy model. Am J Physiol 271(6 Pt 2):R1529–R1534

    PubMed  CAS  Google Scholar 

  11. Mukherjee R, Hewett KW, Spinale FG (1995) Myocyte electrophysiological properties following the development of supraventricular tachycardia-induced cardiomyopathy. J Mol Cell Cardiol 27(6):1333–1348. doi:S0022-2828(05)82396-X[pii]

    Article  PubMed  CAS  Google Scholar 

  12. McMahon WS, Mukherjee R, Gillette PC, Crawford FA, Spinale FG (1996) Right and left ventricular geometry and myocyte contractile processes with dilated cardiomyopathy: myocyte growth and beta-adrenergic responsiveness. Cardiovasc Res 31(2):314–323. doi:0008-6363(95)00212-X[pii]

    PubMed  CAS  Google Scholar 

  13. Nia AM, Caglayan E, Gassanov N, Zimmermann T, Aslan O, Hellmich M, Duru F, Erdmann E, Rosenkranz S, Er F (2010) Beta1-adrenoceptor polymorphism predicts flecainide action in patients with atrial fibrillation. PLoS One 5(7):e11421. doi:10.1371/journal.pone.0011421

    Article  PubMed  Google Scholar 

  14. Er F, Aslan O, Caglayan E, Gassanov N, Nia AM, Erdmann E, Rosenkranz S (2010) Flecainide for cardioversion in patients at elevated cardiovascular risk and persistent atrial fibrillation: a prospective observational study. Clin Res Cardiol 99(6):369–373. doi:10.1007/s00392-010-0129-7

    Article  PubMed  CAS  Google Scholar 

  15. Letsas KP, Filippatos GS, Pappas LK, Mihas CC, Markou V, Alexanian IP, Efremidis M, Sideris A, Maisel AS, Kardaras F (2009) Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clin Res Cardiol 98(2):101–106. doi:10.1007/s00392-008-0728-8

    Article  PubMed  CAS  Google Scholar 

  16. Steinhoff JP, Sheahan RG (2005) Tachycardia-induced cardiomyopathy: atrial fibrillation and congestive heart failure. Am J Med Sci 329(1):25–28. doi:00000441-200501000-00006[pii]

    Article  PubMed  Google Scholar 

  17. Dickstein K (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. Reply. Eur Heart J. doi: 10.1093/eurheartj/ehn561

  18. Nagaya N, Nishikimi T, Okano Y, Uematsu M, Satoh T, Kyotani S, Kuribayashi S, Hamada S, Kakishita M, Nakanishi N, Takamiya M, Kunieda T, Matsuo H, Kangawa K (1998) Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 31(1):202–208. doi:S0735-1097(97)00452-X[pii]

    Article  PubMed  CAS  Google Scholar 

  19. Weber M, Arnold R, Rau M, Elsaesser A, Brandt R, Mitrovic V, Hamm C (2005) Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease. Eur Heart J 26(10):1023–1030. doi:10.1093/eurheartj/ehi236

    Article  PubMed  CAS  Google Scholar 

  20. Golbasy Z, Ucar O, Yuksel AG, Gulel O, Aydogdu S, Ulusoy V (2004) Plasma brain natriuretic peptide levels in patients with rheumatic heart disease. Eur J Heart Fail 6(6):757–760. doi:10.1016/j.ejheart.2004.04.018

    Article  PubMed  Google Scholar 

  21. Yamaguchi H, Yoshida J, Yamamoto K, Sakata Y, Mano T, Akehi N, Hori M, Lim YJ, Mishima M, Masuyama T (2004) Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy. J Am Coll Cardiol 43(1):55–60. doi:S0735109703013718[pii]

    Article  PubMed  CAS  Google Scholar 

  22. Silvet H, Young-Xu Y, Walleigh D, Ravid S (2003) Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 92(9):1124–1127. doi:S0002914903010531[pii]

    Article  PubMed  CAS  Google Scholar 

  23. Simon T, Becker R, Voss F, Bikou O, Hauck M, Licka M, Katus HA, Bauer A (2008) Elevated B-type natriuretic peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res Cardiol 97(5):306–309. doi:10.1007/s00392-007-0629-2

    Article  PubMed  CAS  Google Scholar 

  24. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 138(1):W1–W12. doi:200301070-00012-W1[pii]

    PubMed  Google Scholar 

  25. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463. doi:10.1016/j.echo.2005.10.005

    Article  PubMed  Google Scholar 

  26. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15(2):167–184. doi:S089473170245599X[pii]

    Article  PubMed  Google Scholar 

  27. Wang CL, Lin KH, Luqman N, Chu PH, Hsu LA, Kuo CT (2004) Simultaneous biplane single-beat assessment of left ventricular systolic function in patients with atrial fibrillation. Am J Cardiol 94(7):942–944. doi:10.1016/j.amjcard.2004.06.035

    Article  PubMed  Google Scholar 

  28. Daneshvar D, Wei J, Tolstrup K, Thomson LE, Shufelt C, Merz CN (2010) Diastolic dysfunction: improved understanding using emerging imaging techniques. Am Heart J 160(3):394–404. doi:10.1016/j.ahj.2010.06.040

    Article  PubMed  Google Scholar 

  29. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A, Echocardiography AS (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10(2):165–193. doi:0.1093/ejechocard/jep007

    Article  PubMed  Google Scholar 

  30. Medi C, Kalman JM, Haqqani H, Vohra JK, Morton JB, Sparks PB, Kistler PM (2009) Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: long-term outcome after catheter ablation. J Am Coll Cardiol 53(19):1791–1797. doi:10.1016/j.jacc.2009.02.014

    Article  PubMed  Google Scholar 

  31. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347(23):1825–1833. doi:10.1056/NEJMoa021328

    Article  PubMed  CAS  Google Scholar 

  32. Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347(23):1834–1840. doi:10.1056/NEJMoa021375

    Article  PubMed  Google Scholar 

  33. Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358(25):2667–2677. doi:10.1056/NEJMoa0708789

    Article  PubMed  CAS  Google Scholar 

  34. Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, Hillege HL, Bergsma-Kadijk JA, Cornel JH, Kamp O, Tukkie R, Bosker HA, Van Veldhuisen DJ, Van den Berg MP (2010) Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 362(15):1363–1373. doi:10.1056/NEJMoa1001337

    Article  PubMed  Google Scholar 

  35. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442. doi:10.1093/eurheartj/ehn309

    Article  PubMed  CAS  Google Scholar 

  36. Jessup M, Abraham WT, DE Casey, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009) 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the international society for heart and lung transplantation. Circulation 119(14):1977–2016. doi:10.1161/CIRCULATIONAHA.109.192064

    Article  PubMed  Google Scholar 

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The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

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Correspondence to Fikret Er.

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A. M. Nia and N. Gassanov contributed equally to this study.

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Nia, A.M., Gassanov, N., Dahlem, K.M. et al. Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study. Clin Res Cardiol 100, 887–896 (2011). https://doi.org/10.1007/s00392-011-0319-y

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