Screening for Left Ventricular Dysfunction May Have Less Value Than Thought
Evaluation of NT-proBNP in patients may lead to early exclusion of left ventricular dysfunction, according to a study in Journal of Cardiac Failure
Philadelphia, PA 11 June 2009 – The value and cost-effectiveness of screening for left ventricular (LV) dysfunction remains unclear, particularly since specific, evidence-based treatments are not available for the majority of patients with preserved systolic dysfunction, reports a study in the June issue of the Journal of Cardiac Failure, published by Elsevier.
In the study,1012 primary care patients with hypertension and/or diabetes without signs or symptoms of heart failure were screened for asymptomatic left ventricular dysfunction (ALVD), using measurements of NT-pro-BNP and echocardiography. Diastolic dysfunction was found in 368 subjects (36%) and was categorized as mild in 327 and moderate-severe in 41. Systolic dysfunction was present in only 11 (1.1%)l. NT-proBNP levels were 170±206 and 859±661 pg/mL respectively in diastolic and systolic dysfunction and 92±169 in normal subjects (p<.0001).
For the 52 subjects (5.1%) with moderate to severe diastolic dysfunction or systolic dysfunction, a NT-proBNP of <125 pg/ml had a negative predictive value (NPV) >99% and a positive predictive value of 33% in patients <67 years. For older patients, NPV was 100%, but PPV was somewhat lower in women (23%) than in men (33%).
This study suggests that the evaluation of NT-proBNP in asymptomatic patients with type 2 diabetes or hypertension may lead to very early exclusion of LV dysfunction. As a perspective of this study, general practitioners could use NT-proBNP determination to rule out heart failure (HF) in these patients, a much more cost effective measure than the use of an echocardiographic one. The study was partially supported by an unrestricted grant from Roche Diagnostics.
“This study demonstrates that low values of NT-proBNP usually exclude significant LV dysfunction, but elevated values are relatively non-specific, especially in a population where systolic dysfunction is rare,” comments Barry M. Massie, M.D., Editor-in-Chief of theJournal of Cardiac Failure.
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Notes to Editors:
The full study is “The Role of N-Terminal PRO-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure: The PROBE-HF Study” by Irene Betti, Gabriele Castelli, Alessandro Barchielli, Cinzia Beligni, Vittorio Boscherini, Leonardo De Luca, Gianni Messeri, Mihai Gheorghiade, Alan Maisel, and Alfredo Zuppiroli. Journal of Cardiac Failure. Volume 15, Issue 5, June 2009, Pages 377-384. http://dx.doi.org/10.1016/j.cardfail.2008.12.002
About Journal of Cardiac Failure
Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure—pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment. Journal of Cardiac Failure is the official journal of the Heart Failure Society of America and the Japanese Heart Failure Society. It has an Impact Factor of 3.067 (the highest among journals with a heart failure focus and 19th among all cardiovascular journals) and an Immediacy Factor of 1.306, the 7th among all cardiovascular journals.
About the Heart Failure Society of America
The Heart Failure Society of America (HFSA) is a nonprofit educational organization, founded in 1994 as the first organized association of heart failure experts. Today HFSA has over 1,700 members and provides a forum for all those interested in heart function, heart failure research and patient care. The Society also serves as a resource for governmental agencies (FDA, NIH, NHLBI, CMS). Additional information on HFSA can be found at www.hfsa.org.
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