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Correlation between energy loss index and B-type natriuretic peptide: a vector flow mapping study

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Abstract

Background

Vector Flow Mapping (VFM) and Energy Loss (EL) evaluation are emerging echocardiographic techniques that offer detailed insights into cardiac function. This study aimed to explore the relationship between EL parameters and B-type natriuretic peptide (BNP) levels, a well-established marker of heart failure severity.

Methods

Our study prospectively enrolled 62 patients experiencing shortness of breath and suspected heart failure, who underwent echocardiography and had BNP levels measured between January 2018 and August 2020. Patients were stratified based on BNP levels, and their clinical and echocardiographic characteristics were evaluated. Univariate and multivariate regression analyses were performed to assess the correlation between BNP levels and various echocardiographic variables, including VFM parameters.

Results

Patients were stratified into two groups based on their BNP levels: BNP < 200 pg/ml (n = 53) and BNP ≥ 200 pg/ml (n = 9). Patients with BNP ≥ 200 pg/ml presented significantly different clinical and echocardiographic characteristics, such as older age, larger left ventricular mass and volume indices, higher pulmonary artery systolic pressure, higher E/e’ ratio, and larger EL parameters. Multivariate regression analysis demonstrated the E/e’ ratio and ELA (EL during Atrial contraction phase/A wave ratio as significant determinants of logBNP. Receiver operating characteristic curve analysis showed ELA/A > 36.0 J/m2 as a significant predictor of high BNP with 89% sensitivity and 85% specificity. ELA/A demonstrated an incremental diagnostic value over elevated left atrial pressure for predicting high BNP (C statistic = 0.98 vs 0.74, P = 0.006).

Conclusion

This study provides novel insights into the potential utility of EL parameters as auxiliary indicators of cardiac load, thereby enhancing our understanding of heart failure.

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Data availability

Data are available on reasonable request.

Abbreviations

VFM:

Vector flow mapping

EL:

Energy loss

BNP:

B-type natriuretic peptide

LV:

Left ventricular

LA:

Left atrial

ELS:

EL during systolic phase

ELE:

EL during early diastolic phase

ELA:

EL during atrial contraction phase

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Funding

This work was partially supported by grants from JSPS Kakenhi Grants (Number 23K07509 to K. Kusunose) and the Japan Agency for Medical Research and Development (AMED, JP22uk1024007 to K.K.).

Author information

Authors and Affiliations

  1. Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan

    Sae Morita, Yukina Hirata & Susumu Nishio

  2. Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan

    Tomonori Takahashi, Yoshihito Saijo, Masataka Sata & Kenya Kusunose

  3. Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Hirotsugu Yamada

  4. Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara Town, 207 Uehara, Okinawa, Japan

    Kenya Kusunose

Authors
  1. Sae Morita
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  2. Yukina Hirata
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  3. Susumu Nishio
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  4. Tomonori Takahashi
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  5. Yoshihito Saijo
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  6. Hirotsugu Yamada
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  7. Masataka Sata
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  8. Kenya Kusunose
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Contributions

KK conceived the idea for this study. SM conducted the data analyses. The initial draft of the manuscript was produced by SM and KK. All the authors were involved in interpreting the results and writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenya Kusunose.

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Conflict of interest

None.

Ethics approval

The study was approved by the local ethics committee and Institutional Review Board of the University of Tokushima (protocol: 4287).

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Morita, S., Hirata, Y., Nishio, S. et al. Correlation between energy loss index and B-type natriuretic peptide: a vector flow mapping study. J Echocardiogr 22, 25–33 (2024). https://doi.org/10.1007/s12574-023-00623-x

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  • DOI: https://doi.org/10.1007/s12574-023-00623-x

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