Biochemical detection of left-ventricular systolic dysfunction

McDonagh, TA; Robb, Stephen; Murdoch,; Morton, J.; Ford, Ian; Morrison, CE; Tunstall‐Pedoe, Hugh; McMurray, John J.V.; Dargie, H. J.

doi:10.1016/s0140-6736(97)03034-1

Cited by 883 publications

(576 citation statements)

References 19 publications

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“…Tested by a ROC curve, the diagnostic capacities of NT-proBNP were better compared to ANP, and no additional information was obtained by combining NT-proBNP with ANP. Similar to our findings, in earlier studies with a direct comparison between atrial and brain natriuretic peptides, an advantage for brain natriuretic peptides was convincingly proved with no increased predictive power by addition of ANP to BNP determination (Davidson et al, 1996;Cowie et al, 1997;McDonagh et al, 1998;Hammerer-Lercher et al, 2001). Natriuretic peptides are mainly produced and excreted in the atria of the heart in response to increased wall tension.…”

Section: Discussionsupporting

confidence: 91%

“…In this study with 32 patients, we found NT-proBNP to be a reliable marker to make this differentiation with a sensitivity of 100% and a specificity of 83%. This is comparable to the literature for diagnosis of cardiac dysfunction in the general population (McDonagh et al, 1998;Luchner et al, 2000) or in patients suspected to have heart failure (Cowie et al, 1997;Maisel et al, 2002Maisel et al, , 2003. The PPV of 69% as described in our study is relatively high compared to studies in the general population with a PPV of approximately 30% (Bay et al, Figure 3 The ROC curve shows that the accuracy to differentiate between patients with and without heart disease is the best in NT-proBNP compared to ANP levels.…”

Section: Discussionsupporting

confidence: 86%

“…Large studies in the general population or in noncardiac patients showed that measuring natriuretic peptides might be an effective screening method for left-ventricular systolic dysfunction (McDonagh et al, 1998;Luchner et al, 2000;Bay et al, 2003). In patients with the suspicion of heart failure several other studies showed natriuretic peptides to be useful indicators for the detection of heart failure (Lerman et al, 1993;Davidson et al, 1996;Cowie et al, 1997;Hammerer-Lercher et al, 2001;Maisel et al, 2002Maisel et al, , 2003.…”

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Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

et al. 2004

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Carcinoid heart disease (CHD) occurs in 20 -70% of the patients with metastatic well-differentiated neuroendocrine tumours (NET). We evaluated whether natriuretic peptides (ANP or NT-proBNP) are useful in early detection of CHD. Blood samples from 32 patients with NET were compared with cardiac ultrasound follow-up. CHD was defined as thickening of the tricuspid valve in the presence of grade III -IV/IV tricuspid valve regurgitation. CHD was found in nine out of 32 patients (28%), all with symptoms of the carcinoid syndrome compared to 65% in the 23 patients without CHD (P ¼ 0.04). Median levels of NT-proBNP and 5-HIAA were significantly higher in patients with CHD (894 ng l À1 and 815 mmol 24 h À1 ) compared to those without (89 and 206 ng l À1 , Po0.001 and P ¼ 0.007). No significant differences were detected in ANP levels (P ¼ 0.11). Dilatation of the right atrium and ventricle as well as thickening of the tricuspid valve and degree of regurgitation were statistically significant correlated with NT-proBNP levels. The accuracy of NT-proBNP in the diagnosis of CHD was higher than that of ANP. A significantly better survival was observed in case of normal NT-proBNP values. In conclusion, NT-proBNP is helpful as a simple marker in the diagnosis of CHD. Survival is better in patients with normal levels of NT-proBNP.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

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Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

et al. 2004

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“…Asymptomatic LV dysfunction carries the risk of symptom development and may warrant treatment in itself [9] but should not be considered as heart failure. Serum biochemical markers, such as BNP and NT-ANP, are promising markers of LV systolic dysfunction but only 50% of patients with raised BNP and L VEF < 30% may experience symptoms [10]. A definition of heart failure which relies rigidly on a single global parameter of cardiac function will lack sensitivity as abnormal cardiac function may be regional or only manifest at maximal exercise.…”

Section: Features Of Definition Advantagesmentioning

confidence: 99%

“…Flexible clinical definitions of this kind may be found useful by the physician required to appraise clinical information on a patil~nt who does not conform to a rigid definition from an epidemiology or clinical science study. [7][8][9][10] Current definitions of heart failure do not incorporate the contribution of diastolic dysfunction. Clinical definitions are often inadequate because the symptoms and signs of diastolic failure tend to be less than systolic failure.…”

Section: Features Of Definition Advantagesmentioning

confidence: 99%

Heart failure: why and how to define it?

Purcell¹,

Poole‐Wilson²

1999

European J of Heart Fail

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A Systematic Review of the Diagnostic Accuracy of Natriuretic Peptides for Heart Failure

Doust¹,

Glasziou²,

Pietrzak³

et al. 2004

Arch Intern Med

291

181

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Background:The diagnosis of heart failure is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Natriuretic peptides have been proposed as a possible test for assisting diagnosis. We assessed the diagnostic accuracy of brain natriuretic peptide (BNP), including a comparison with atrial natriuretic peptide (ANP).Methods: Electronic searches were conducted of MEDLINE and EMBASE from January 1994 to December 2002 and handsearches of reference lists of included studies. We included studies that assessed the diagnostic accuracy of BNP against echocardiographic or clinical criteria or that compared the diagnostic accuracy of BNP with ANP. Two reviewers assessed studies for inclusion and quality and extracted the relevant data. A meta-analysis was performed by pooling the diagnostic odds ratios for studies that used a common reference standard.Results: Twenty studies were included. For the 8 studies (n=4086) that measured BNP against the criterion of left ventricular ejection fraction of 40% or less (or equiva-lent), the pooled diagnostic odds ratio was 11.6 (95% confidence interval, 8.4-16.1). The pooled diagnostic odds ratio was greater, 30.9 (95% confidence interval, 27.0-35.4), in the 7 studies (n = 2374) that measured BNP against clinical criteria (generally a consensus view using all other clinical information). The diagnostic odds ratio was similar in studies conducted in general practice and in hospital settings. Three studies compared BNP with N-terminal-ANP, a precursor form of ANP, and pooling of the results of these studies showed BNP to be a more accurate marker of heart failure than NT-ANP.Conclusions: Brain natriuretic peptide is an accurate marker of heart failure. Use of a cutoff value of 15 pmol/L achieves high sensitivity, and BNP values below this exclude heart failure in patients in whom disease is suspected. As the diagnostic odds ratio for BNP is greater when assessed against clinical criteria than against left ejection fraction alone, BNP may also be detecting patients with "diastolic" heart failure.

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Biochemical detection of left-ventricular systolic dysfunction

Cited by 883 publications

References 19 publications

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

Heart failure: why and how to define it?

A Systematic Review of the Diagnostic Accuracy of Natriuretic Peptides for Heart Failure

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