Screening the population for left ventricular hypertrophy and left ventricular systolic dysfunction using natriuretic peptides: Results from the Dallas Heart Study

• Published in: The American heart journal Vol. 157; no. 4; pp. 746 - 753.e2
• Main Authors: de Lemos, James A., MD, McGuire, Darren K., MD, MHSc, Khera, Amit, MD, MSc, Das, Sandeep R., MD, MPH, Murphy, Sabina A., MPH, Omland, Torbjorn, MD, PhD, MPH, Drazner, Mark H., MD, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2009; Mosby; Elsevier Limited
• Subjects: Adult; Age; Aged; Biological and medical sciences; Body mass index; Cardiology. Vascular system; Cardiovascular; Echocardiography; Female; Gender; Heart; Heart attacks; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertension; Hypertrophy, Left Ventricular - blood; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - epidemiology; Magnetic Resonance Imaging; Male; Mass Screening - methods; Medical imaging; Medical sciences; Middle Aged; Morbidity; Mortality; Myocardial Contraction - physiology; Natriuretic Peptides - blood; Peptides; Prognosis; Retrospective Studies; Statistical methods; Systole; Texas; Tomography, X-Ray Computed; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - epidemiology; Texas; Heart; Peptides; Cardiovascular disease; Heart ventricle; Left ventricular failure; Medical screening; Left ventricle; Result; Heart disease; Population; Circulatory system; Cardiology; Left ventricle performance; Hypertrophy
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2008.12.017

Background Identification of individuals in the community with left ventricular systolic dysfunction (LVSD) or left ventricular hypertrophy (LVH) may allow earlier initiation of disease-modifying treatment. We performed a comprehensive evaluation of the screening performance of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for LVSD or LVH. Methods In 2,429 subjects without a history of heart failure, myocardial infarction, valvular abnormalities, or a serum creatinine >2.0 mg/dL enrolled in the Dallas Heart Study, measurement of BNP and NT-proBNP and cardiovascular magnetic resonance imaging were performed. Results B-type natriuretic peptide and NT-proBNP were robustly associated with magnetic resonance imaging–defined LVH and LVSD (ejection fraction <55%) among men and women ( P < .0001 for each). In the overall population, neither test discriminated well for LVH or LVSD (area under the receiver operating characteristic curve [AUROC] <0.7). Among women, no differences in AUROC were observed between BNP and NT-proBNP. Among men, AUROCs were similar between BNP and NT-proBNP in the overall population, but among subgroups age 50 or older, or with hypertension, the AUROCs for NT-proBNP (0.73-0.79) were higher than for BNP (0.63-0.69, P < .05 for each comparison). Compared with subjects with isolated BNP elevation (>97.5th percentile), those with isolated NT-proBNP elevation had worse renal function and more LVH and coronary calcium ( P < .05 for each). Conclusions Overall, neither BNP nor NT-proBNP accurately discriminated subjects with LVH or LVSD in this predominately young and healthy population-based cohort. However, among high-risk men, NT-proBNP performed slightly better than BNP and comparably with other routinely used screening tests such as prostate-specific antigen measurement for prostate cancer.