Population-based detection of systolic and diastolic dysfunction with amino-terminal pro–B-type natriuretic peptide - 18/08/11
, Thomas H. Marwick, MBBS, PhD c, Niels G. Becker, BSc, MSc, PhD b, Ian M. Jeffery, MBBS a, Darryl A. McGill, BSc, MBBS, PhD a, Wayne T. Smith, BMed, MPH, PhD dAbstract |
Background |
There is limited information regarding the clinical utility of amino-terminal pro–B-type natriuretic peptide (NT-proBNP) for the detection of left ventricular (LV) dysfunction in the community. We evaluated predictors of circulating NT-proBNP levels and determined the utility of NT-proBNP to detect systolic and diastolic LV dysfunction in older adults.
Methods |
A population-based sample of 1229 older adults (mean age 69.4 years, 50.1% women) underwent echocardiographic assessment of cardiac structure and function and measurement of circulating NT-proBNP levels.
Results |
Predictors of NT-proBNP included age, female sex, body mass index, and cardiorenal parameters (diastolic dysfunction [DD] severity; LV mass and left atrial volume; right ventricular overload; decreasing ejection fraction [EF] and creatinine clearance). The performance of NT-proBNP to detect any degree of LV dysfunction, including mild DD, was poor (area under the curve 0.56-0.66). In contrast, the performance of NT-proBNP for the detection of EF ≤ 40% and moderate-severe DD was strong with area under the curve of >0.90 regardless of age and sex; history of hypertension, diabetes, coronary artery disease; or body mass category. The ability of NT-proBNP to detect EF ≤ 40% and/or moderate-severe DD was optimized by using age/sex-specific limits. Of “false-positive” tests, 88% (124/141) were explained after considering cardiorenal determinants of NT-proBNP levels.
Conclusions |
Amino-terminal pro–B-type natriuretic peptide is a suboptimal marker of mild LV dysfunction, but performs strongly as a marker of EF ≤ 40% and/or moderate-severe DD in the community. Most subjects with a positive NT-proBNP test, using age/sex-specific cutoffs, had prognostically significant abnormalities of cardiac structure or function.
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| This study was supported by a grant from the Canberra Hospital Salaried Medical Officers' Private Practice Fund. |
Vol 152 - N° 5
P. 941-948 - novembre 2006 Retour au numéro
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