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Global longitudinal strain: the best at predicting NT-proBNP levels in acute coronary syndrome?
Session:
Painel 6 - Doença Coronária 7
Speaker:
Ana Rita Gomes
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ana Rita M. Gomes; Diana Decampos; Carolina Saleiro; João Lopes; José Pedro Sousa; Luís Puga; Joana M. Ribeiro; Natália António; Lino Gonçalves
Abstract
<p><strong>Background:</strong> The levels of NT-proBNP are inversely related to left ventricular ejection fraction (LVEF) in acute coronary syndrome (ACS). Global left ventricular longitudinal strain (GLS) reflects deformation properties of the myocardium. Limited data exists on the association between NT-proBNP levels and GLS.</p> <p><strong>Methods:</strong> Retrospective analysis of 106 consecutive patients admitted with an ACS to a single Intensive Coronary Unit between 2013 and 2016. Two-dimensional speckle tracking of the left ventricle was assessed and average GLS was calculated using 2, 3 and 4-chamber views. NT-proBNP levels were measured upon patients’ admission and were logarithmically transformed (log<sub>10</sub>). Median levels of log(NT-proBNP) were used to divide patients into two groups. A linear regression analysis was performed to determine the correlation between NT-proBNP levels and GLS.</p> <p><strong>Results:</strong> Mean age was 67.1±12.3 years old and 78.3% of patients were male. LVEF mean was 49.4±9.8% and average GLS was -16.0±4.0%. NT-proBNP ranged from 12.8 to 106000.0 pg/mL, with a median of 850±3318.3 pg/mL. About a third (36.8%) had Killip-Kimball (KK) class ≥II. Patients with worse GLS had higher levels of NT-proBNP (<em>P</em><0.001). Correlation between GLS and log(NT-proBNP) was significant (P<0.001, R=0.49), explaining 24% of its variation. Linear relationship between log(NT-proBNP) and LVEF was significant but with lower Beta coefficient and R<sup>2</sup>. In multiple regression analysis (including GLS, KK class ≥II, age and troponin I), GLS emerged as an independent predictor of log(NT-proBNP) (Beta=0.65, P<0.001, overall R<sup>2</sup>=0.42). No significant explanatory value for KK class ≥II and troponin I emerged. The AUC of GLS to predict log(NT-proBNP) above the median was 0.76 (P<0.001, sensitivity 71.4% and specificity 73.8%). A GLS ≤ |-16.1|% was the cutoff value associated with higher levels of NT-proBNP.</p> <p><strong>Conclusions:</strong> An impaired GLS of the left ventricle was an independent predictor of NT-proBNP levels in ACS patients, being superior to LVEF.</p>
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