LAUSR

INTRODUCTION Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice. AIM The aim of our study was to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricle ejection fraction (LVEF) and HF symptoms. METHODS All the consecutive patients with HF symptoms, preserved LVEF and suspected DD were examined in transthoracic echocardiography (TTE) and DSE using the protocol according to the ASE recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro atrial natriuretic peptide (MR-proANP) and serum soluble ST2 receptor (ST2). RESULTS The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association scale IIa - 53; IIb - 17; III - 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%) and known coronary artery disease (10%). The rest transthoracic echocardiographic (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P <0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P <0.01), E/e' rest (AUC, 0.790; P <0.01) and baseline NT-proBNP (AUC, 0.713; P <0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT or e' were not predictive for DSE result. CONCLUSIONS DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value towards diastolic dysfunction.