Natriuretic peptides in the detection of preclinical diastolic or systolic dysfunction

• Published in: Clinical research in cardiology Vol. 99; no. 4; pp. 217 - 226
• Main Authors: Luers, Claus, Wachter, Rolf, Kleta, Sibylle, Uhlir, Marc, Koschack, Janka, Scherer, Martin, Binder, Lutz, Herrmann-Lingen, Christoph, Zapf, Antonia, Kulle, Bettina, Kochen, Michael M, Pieske, Burkert
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.04.2010; Springer-Verlag; Springer Nature B.V
• Subjects: Aged; Cardiology; Diastole; Echocardiography - methods; Heart Failure, Diastolic - diagnosis; Heart Failure, Diastolic - etiology; Heart Failure, Systolic - diagnosis; Heart Failure, Systolic - etiology; Humans; In Vitro Techniques; Mass Screening - methods; Medicine; Medicine & Public Health; Middle Aged; Natriuretic Peptides - metabolism; Original Paper; Prevalence; Primary Health Care - methods; Prospective Studies; Risk Factors; Severity of Illness Index; Systole; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology; Heart failure; Diastolic dysfunction; Natriuretic peptides; Left ventricular function
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-009-0108-z

Aims The diagnostic value of natriuretic peptides in asymptomatic patients at risk for diastolic or systolic HF is controversial. We tested (1) the prevalence of preclinical LV dysfunction in an at-risk cohort; (2) the diagnostic accuracy of natriuretic peptides alone or in combination with clinical parameters for predicting asymptomatic left ventricular systolic or diastolic dysfunction. Methods 542 primary care patients (mean age 63 ± 11 years, 42% female) without prediagnosed HF, but with risk factors for left ventricular dysfunction, underwent thorough cardiological workup, including echocardiography and analysis of natriuretic peptides. Results 23 patients (4%) showed reduced systolic function (EF < 50%), and 15 patients (3%) had severe diastolic dysfunction. All natriuretic peptides significantly increased with decreasing ejection fraction and with increasing degree of diastolic dysfunction. For natriuretic peptides, receiver operating characteristics analysis yielded good results for the detection of systolic dysfunction or severe diastolic dysfunction. Combining clinical parameters with natriuretic peptide data improved the diagnostic accuracy and largely reduced the number of needed screening echoes to identify patients with LV systolic or diastolic dysfunction. Conclusions The prevalence of preclinical diastolic dysfunction is high in primary care patients at risk, but the relative prevalence of severe diastolic dysfunction and systolic dysfunction is only 7%. High-risk individuals may be screened most efficiently by using a score system incorporating clinical data and NT-proBNP.