Turk Kardiyol Dern Ars. 2007; 35(3): 158-164

The effect of frequent ventricular premature beats originating from the right ventricular outflow tract on left ventricular diastolic functions and their relationship with serum N-terminal proBNP levels

Serkan Topaloğlu, Göksel Cağırcı, Kumral Ergün, Emre Nuri Günel, Serkan Çay, Ali Yıldız, Dursun Aras, Ömer Alyan, Kazım Başer, Ayça Boyacı, Şule Korkmaz
Türkiye Yuksek Ihtisas Hospital, Department Of Cardiology, Ankara, Turkey

OBJECTIVES
We investigated the effect of frequent ventricular premature beats (VPB) originating from the right ventricular outflow tract (RVOT) on diastolic functions and the relationship between VPBs and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.

STUDY DESIGN
The study included 33 symptomatic patients (10 males, 23 females; mean age 40±8 years) with normal left ventricular functions, who had frequent VPBs originating from the RVOT on 24-hour Holter monitoring. All the patients underwent 2D transthoracic echocardiography and Doppler analyses and mitral inflow patterns and serum NT-proBNP levels were evaluated. The results were compared with those of 30 healthy individuals (9 males, 21 females; 37±9 years).

RESULTS
Compared to the controls, the patients had a longer isovolumetric relaxation time (IVRT) (p<0.0001) and E-wave deceleration time (EDT) (p<0.0001), a smaller ratio of early diastolic wave to atrial wave (E/A) (p=0.001), and higher NT-proBNP levels (p=0.016). While the mitral inflow pattern was normal in all the controls, it was associated with impaired relaxation in 13 patients. Patients with diastolic dysfunction (n=13) had higher NT-proBNP levels (p=0.03) and greater VPB counts (p=0.001) than those without diastolic dysfunction (n=20). The number of VPBs was inversely correlated with the mitral E/A ratio, and positively correlated with EDT, IVRT, and NT-proBNP levels.

CONCLUSION
Frequent VPBs from the RVOT cause deterioration in diastolic functions in patients without structural heart disease. Considering a parallel rise in NT-proBNP levels with the VPB count, NT-proBNP measurement can be used as a predictor of diastolic dysfunction in symptomatic patients.

Keywords: Echocardiography, Doppler, heart ventricles; natriuretic peptide, brain/metabolism; ventricular function, left; ventricular premature complexes

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