Biochemical detection of left-ventricular systolic dysfunction

• Published in: The Lancet (British edition) Vol. 351; no. 9095; pp. 9 - 13
• Main Authors: McDonagh, TA, Robb, SD, Murdoch, DR, Morton, JJ, Ford, I, Morrison, CE, Tunstall-Pedoe, H, McMurray, JJV, Dargie, HJ
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 03.01.1998; Lancet; Elsevier Limited
• Subjects: Adult; Aged; Atrial Natriuretic Factor - blood; Biochemistry; Biological and medical sciences; Biomarkers - blood; Brain; Cardiology. Vascular system; Echocardiography; Electrocardiography; Female; Heart; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - prevention & control; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Mass Screening - methods; Medical sciences; Medical screening; Middle Aged; Natriuresis; Natriuretic Peptide, Brain; Nerve Tissue Proteins - blood; Peptides; Predictive Value of Tests; Random Allocation; ROC Curve; Scotland - epidemiology; Sensitivity and Specificity; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - prevention & control; Scotland; Performance evaluation; Human; Heart failure; Brain natriuretic peptide; Cardiovascular disease; Heart ventricle; Atrial natriuretic peptide; Left ventricular failure; Medical screening; N terminal peptide; Blood plasma; Chronic; Heart disease
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(97)03034-1

In previous studies on the use of natriuretic peptides to detect left-ventricular systolic dysfunction, a higher rate of cardiac disorders in the control groups than in the study groups could have led to bias. We investigated the effectiveness of plasma N-terminal atrial natriuretic peptide (NT-ANP) and brain natriuretic peptide (BNP) concentrations to show left-ventricular systolic dysfunction in a random sample of the general population. We randomly selected 2000 participants aged 25–74 years from family physicians' lists in Glasgow, UK. We sent all participants questionnaires. 1653 respondents underwent echocardiography and electrocardiography. We took a left-ventricular ejection fraction of 30% or less to show left-ventricular systolic dysfunction. NT-ANP and BNP were measured in plasma by RIAs. 1252 participants had analysable electrocardiograms and echocardiograms, completed questionnaires, and available blood samples. Median concentrations of NT-ANP and BNP were significantly higher in participants with left-ventricular systolic dysfunction (2·8 ng/mL [IQR 1·8–4·6] and 24·0 pg/mL [18·0–33·0]) than in those without (1·3 ng/mL [0·9–1·8] and 7·7 pg/mL [3·4–13·0]; each p<0·001). Among participants with left-ventricular systolic dysfunction, both symptomatic and asymptomatic subgroups had raised NT-ANP and BNP concentrations. A BNP concentration of 17·9 pg/mL or more gave a sensitivity of 77% and specificity of 87% in all participants, and 92% and 72% in participants aged 55 years or older. Measurement of BNP could be a cost-effective method of screening for left-ventricular systolic dysfunction in the general population, especially if its use were targeted to individuals at high risk.