Clinical Research in Cardiology

, Volume 100, Issue 10, pp 887–896

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

  • Amir M. Nia
  • Natig Gassanov
  • Kristina M. Dahlem
  • Evren Caglayan
  • Martin Hellmich
  • Erland Erdmann
  • Fikret Er
Original Paper

DOI: 10.1007/s00392-011-0319-y

Cite this article as:
Nia, A.M., Gassanov, N., Dahlem, K.M. et al. Clin Res Cardiol (2011) 100: 887. doi:10.1007/s00392-011-0319-y

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.

Keywords

Tachycardia-mediated cardiomyopathy NT-proBNP Tachyarrhythmia Heart failure 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Amir M. Nia
    • 1
  • Natig Gassanov
    • 1
  • Kristina M. Dahlem
    • 1
  • Evren Caglayan
    • 1
  • Martin Hellmich
    • 2
  • Erland Erdmann
    • 1
  • Fikret Er
    • 1
  1. 1.Department of Internal Medicine IIIUniversity of CologneCologneGermany
  2. 2.Institute of Medical Statistics, Informatics and EpidemiologyUniversity of CologneCologneGermany

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