Clinical Meaning of the Ratio of Brachial Pre-Ejection Period to Brachial Ejection Time in Patients with Left Ventricular Systolic Dysfunction.

An increase in the ratio of the brachial pre-ejection period to brachial ejection time [pre-ejection period (PEP)/ET] is correlated with a decrease of left ventricular ejection fraction (LVEF). The current study was designed to test the hypothesis that the change value (Δ) of PEP/ET is a useful indicator of Δ LVEF in patients with left ventricular systolic dysfunction.We consecutively enrolled 104 patients with left ventricular systolic dysfunction (LVEF < 45%). PEP/ET, B-type natriuretic peptide (BNP), and LVEF were evaluated at baseline and at 6-month follow-up. Compared with the baseline measurements, the 6-month values of ΔLVEF, ΔBNP, and ΔPEP/ET were 9.8% ± 9.0% (from 36.3% ± 9.2% to 46.3% ± 12.5%, P < 0.001), -168.5 ± 255.4 (from 271.4 ± 282.5 to 104.1 ± 129.6, P < 0.001), and -0.060 ± 0.069 (from 0.413 ± 0.097 to 0.358 ± 0.079, P < 0.001), respectively. There were significant correlations between LVEF and PEP/ET and between LVEF and BNP in both the initial (r = -0.316, P = 0.001 and r = -0.598, P < 0.001, respectively) and 6-month follow-up (r = -0.307, P = 0.003 and r = -0.701, P < 0.001, respectively). The Steiger's Z test showed that BNP had a significantly stronger correlation with LVEF compared with the correlations between LVEF and PEP/ET in both the initial and 6-month studies (Z = 2.471, P = 0.013 and Z = 3.575, P < 0.001, respectively). There were also significant correlations between ΔLVEF and ΔPEP/ET (r = -0.515, P < 0.001) and between ΔLVEF and ΔBNP (r = -0.581, P < 0.001); however, there was no difference between the correlations for ΔLVEF and ΔPEP/ET versus ΔLVEF and ΔBNP (Steiger's Z = 0.600, P = 0.545).In patients with left ventricular systolic dysfunction not only ΔBNP but also ΔPEP/ET could be a simple indicator of predicting change of LVEF.

[1]  T. Imamura,et al.  High Dose β-Blocker Therapy Triggers Additional Reverse Remodeling in Patients With Idiopathic Non-Ischemic Cardiomyopathy. , 2016, International heart journal.

[2]  S. Hamada,et al.  B-type natriuretic peptide response and reverse left ventricular remodeling after surgical correction of functional mitral regurgitation in patients with advanced cardiomyopathy. , 2015, Journal of cardiology.

[3]  M. Hori,et al.  Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study. , 2013, International journal of cardiology.

[4]  J. Januzzi,et al.  Are serial BNP measurements useful in heart failure management? Serial natriuretic peptide measurements are useful in heart failure management. , 2013, Circulation.

[5]  Shang-Jyh Hwang,et al.  A systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts cardiovascular events in patients with chronic kidney disease. , 2010, Circulation journal : official journal of the Japanese Circulation Society.

[6]  C. Chu,et al.  Myocardial performance index derived from brachial-ankle pulse wave velocity: a novel and feasible parameter in evaluation of cardiac performance. , 2009, American journal of hypertension.

[7]  J. Cohn,et al.  Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial). , 2008, Journal of the American College of Cardiology.

[8]  J. Zamora,et al.  Accuracy of B‐type natriuretic peptide levels in the diagnosis of left ventricular dysfunction and heart failure: A systematic review , 2006, European journal of heart failure.

[9]  Richard B Devereux,et al.  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 Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[10]  D. Pellerin,et al.  Renewed interest in preejectional isovolumic phase: new applications of tissue Doppler indexes: implications to ventricular dyssynchrony. , 2005, The American journal of cardiology.

[11]  Eva Pietrzak,et al.  A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. , 2004, Archives of internal medicine.

[12]  C. Phillips,et al.  The use of brain natriuretic peptide as a screening test for left ventricular systolic dysfunction- cost-effectiveness in relation to open access echocardiography. , 2003, Family practice.

[13]  Masanori Munakata,et al.  Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. , 2003, American journal of hypertension.

[14]  A. Yamashina,et al.  Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. , 2002, Hypertension research : official journal of the Japanese Society of Hypertension.

[15]  K. Swedberg,et al.  Comprehensive guidelines for the diagnosis and treatment of chronic heart failure Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology , 2002, European journal of heart failure.

[16]  F. Perticone,et al.  Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[17]  M. Quiñones,et al.  Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. , 2000, Journal of the American College of Cardiology.

[18]  D. Pellerin,et al.  Preejectional left ventricular wall motion in normal subjects using Doppler tissue imaging and correlation with ejection fraction. , 1997, The American journal of cardiology.

[19]  F. Manian.  A prospective study of daily measurement of C-reactive protein in serum of adults with neutropenia. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  J. Cohn,et al.  Prognostic Significance of Serial Changes in Left Ventricular Ejection Fraction in Patients With Congestive Heart Failure , 1993, Circulation.

[21]  D. Cokkinos,et al.  Influence of heart rate increase on uncorrected pre-ejection period/left ventricular ejection time (PEP/LVET) ratio in normal individuals. , 1976, British heart journal.

[22]  H. Dodge,et al.  The Relationship of Alterations in Systolic Time Intervals to Ejection Fraction in Patients with Cardiac Disease , 1970, Circulation.

[23]  Richard P. Lewis,et al.  A Critical Review of the Systolic Time Intervals , 2005 .

[24]  T. McDonagh,et al.  Retrospective analysis of the cost-effectiveness of using plasma brain natriuretic peptide in screening for left ventricular systolic dysfunction in the general population. , 2003, Journal of the American College of Cardiology.