A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction

Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening pati...

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Bibliographic Details
Published in:The American heart journal 2004-09, Vol.148 (3), p.518-523
Main Authors: Atisha, Dunya, Bhalla, Meenakshi A., Morrison, L.Katherine, Felicio, Leda, Clopton, Paul, Gardetto, Nancy, Kazanegra, Radmila, Chiu, Albert, Maisel, Alan S.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular disease
Echocardiography
Echocardiography, Doppler, Color
Female
Heart
Heart attacks
Heart Diseases - physiopathology
Humans
Male
Medical prognosis
Medical sciences
Middle Aged
Natriuretic Peptide, Brain - blood
Patients
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Stroke Volume
Ultrasonic imaging
Ventricular Dysfunction, Left - blood
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - diagnostic imaging
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Summary:Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening patients prior to echocardiography. Determining an appropriate BNP level below which the need for echocardiography is precluded would be valuable. We hypothesized that a fixed plasma BNP level of 20 pg/mL and simple clinical parameters are an effective pre-echocardiographic screening tool for left ventricular dysfunction. Two hundred and two patients at a Veterans Administration facility with symptoms suggestive of heart disease (male to female ratio 193:9, mean age 65 years) were screened prior to echocardiography. Patients with known cardiac dysfunction were excluded. BNP levels of ≥20 pg/mL were 79% sensitive and 44% specific in screening for any abnormality of ventricular function. The negative predictive value was 69%. When broken down into categories of dysfunction, the cutoff point of 20 pg/mL had a better negative predictive value for those with systolic dysfunction (96%) or systolic plus diastolic dysfunction (100%) if patients with diastolic dysfunction were excluded. The majority of patients with falsely low BNP levels (
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2004.03.014