5.22 Correlation Between Parameters of Non-invasive Haemodynamic Monitoring, Levels of Natriuretic Peptides and Echocardiographic Indexes of Diastolic Dysfunction in Chronic Systolic Heart Failure

Introduction. The prognostic relevance of diastolic heart failure (HF), either alone or associated with systolic dysfunction, is likely to derive from its relationship with elevated filling pressures, as demonstrated by invasive studies. Since non-invasive evaluation by transthoracic impedance monitoring (TEB) has been proposed for the periodic haemodynamic assessment of patients with HF, we related TEB results with left ventricular diastolic function measured by Tissue Doppler Imaging (TDI) and conventional echocardiography.

Methods. In 50 HF patients with optimal treatment (71+9 years, NYHA 2.4+0.9, EF 31+6%, ACE-I in 91%, ARB in34%, ACEI+-blockers in 81%, ACEI+ ARB+-blockers in 47%, ICD or ICD+resynchronizationin 53%), we performed TEB (Cardiodynamics, BioZ.com) and echocardiography (Vivid 7,GE Inc).

Results. Among TEB variables we considered cardiac index (CI), stroke volume (SV) and thoracic fluid content (TFC). Echocardiographic variables were: left ventricular ejection fraction (EF % ), deceleration time of transmitral flow (DT ms), left ventricular operating stiffness (KLV mmHg /ml), TDI of the velocity of displacement of mitral annulus (E’ m/s) and the ratio E/E’. In all patients, EF was related to CI and SV (R>0.6, p<0.05). Moreover, all indexes of diastolic function (i.e. DT, KLV and E/E’) were significantly related to TFC (R>0.70, p<0.001).

Conclusions. Non-invasive haemodynamic evaluation by transthoracic impedance monitoring confirmed the strict relations hip between thoracic fluid retention and the presence of diastolic dysfunction, assessed either by Doppler echocardiography or by TDI, in patients with prevalently systolic HF. In conclusion, the combined use of TEB and of BNP assessment correctly indicated an abnormal diastolic phase and also a poor pump function. These user-friendly and operator-independent tools may thus serve as a screening assessment of chronic HF patients when an adequate echocardiographic evaluation is not readily available.