Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care

McClure, S.J.; Caruana, L; Davie, Andrew; Goldthorp, S. L.; McMurray, John J.V.

doi:10.1136/bmj.317.7157.516

Cited by 73 publications

(46 citation statements)

References 25 publications

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“…4 -9 However, BNP is not an accurate test for ventricular dysfunction among subjects who do not have overt symptoms of heart failure, 10 especially those with underlying coronary disease. 11 These observations suggest that BNP elevations may be associated with cardiac processes other than ventricular dysfunction.…”

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confidence: 87%

B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

et al. 2003

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Background-In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as myocardial ischemia may also cause elevations in BNP. Methods and Results-To determine whether BNP elevations are associated with myocardial ischemia, we measured plasma BNP levels before performing exercise treadmill testing with stress echocardiography in outpatients with stable coronary disease. Of the 355 participants, 113 (32%) had inducible ischemia. Compared with participants in the lowest BNP quartile (0 to 16.4 pg/mL), those in the highest quartile of BNP (Ն105 pg/mL) had double the risk of inducible ischemia (adjusted relative risk, 2.0; 95% CI, 1.2 to 2.6; Pϭ0.008). The relation between elevated BNP levels and inducible ischemia was especially evident in the 206 participants who had a history of myocardial infarction (adjusted relative risk, 2.6; 95% CI, 1.5 to 3.7, Pϭ0.002) and was absent in those without a history of myocardial infarction (adjusted relative risk, 1.0; 95% CI, 0.3 to 2.2; Pϭ0.9). This association between BNP levels and inducible ischemia remained strong after adjustment for measures of systolic and diastolic dysfunction. Conclusions-Elevated levels of BNP are independently associated with inducible ischemia among outpatients with stable coronary disease, particularly among those with a history of myocardial infarction. The observed association between BNP levels and ischemia may explain why tests for BNP are not specific for ventricular dysfunction among patients with coronary disease.

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confidence: 87%

B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

et al. 2003

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“…Existing studies in primary care have examined populations in which the 2 markers performed similarly in the detection of decreased left ventricular ejection fraction in symptomatic and asymptomatic patients (29)(30)(31)(32). Because of their physiological profile, B-type peptides are generally more accurate in identifying HF and rapidly changing in an evolving response to recent clinical instability (25)(26)32 ), but their use in helping to delineate less specific symptoms of HF in primary care is not yet fully realized.…”

Section: Discussionmentioning

confidence: 99%

Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure

Aspromonte

Ceci

et al. 2006

Clinical Chemistry

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“…BNP seems to have clinical utility in terms of excluding the diagnosis of heart failure in patients with symptoms of breathlessness or fluid retention and may provide prognostic information about those with heart failure or other cardiac diseases. [22][23][24][25][26][27] Also, there is some evidence that it may be useful for monitoring heart failure therapies. 28,29 Yet, little data are available to suggest that BNP may be useful in a pediatric clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants

et al. 2005

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ABSTRACT. Objective. In preterm infants, the rapid and accurate determination of the presence of a hemodynamically significant patent ductus arteriosus (PDA) is extremely important, but this is often difficult. Plasma B-type natriuretic peptide (BNP) measurement has been reported to be a helpful aid in the diagnosis of hemodynamically significant PDA in preterm infants. The aim of our study was to investigate the usefulness of a rapid BNP assay as a diagnostic marker of symptomatic PDA (sPDA) in preterm infants.Methods. Sixty-six preterm infants, ranging from 25 to 34 gestational weeks of age, underwent clinical and echocardiographic examinations for PDA every other day from the third day of life until the disappearance of ductal flow. Blood samples were collected and plasma BNP concentrations were measured simultaneously using a commercial kit, (Triage BNP test kit; Biosite Diagnositics, San Diego, CA). When >2 clinically significant features of PDA were noted, and a large ductal flow was confirmed by color Doppler echocardiography, sPDA was diagnosed and treated with indomethacin.Results. On the third day after birth, the mean BNP concentration in the sPDA group (n ‫؍‬ 23) was significantly higher than in the control group (n ‫؍‬ 43) (2896 ؎ 1627 vs 208 ؎ 313 pg/mL). Seventeen infants (74%) in the sPDA group became asymptomatic after an initial course of indomethacin and their BNP levels concomitantly decreased. Moreover, BNP concentrations were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery (r ‫؍‬ 0.726 and 0.877). The area under the receiver operator characteristic curve for the detection of sPDA was high: 0.997 (95% confidence interval: 0.991-1.004). The best cutoff of BNP concentration for the diagnosis of sPDA was determined to be 1110 pg/mL (sensitivity: 100%; specificity: 95.3%).Conclusion. In preterm infants, the circulating BNP levels correlated well with the clinical and echocardiographic assessments of PDA. Although not a stand-alone test, the rapid BNP assay provides valuable information for the detection of infants with sPDA that require treatment. Moreover, serial BNP measurements may be of value in determining the clinical course of PDA in preterm infants. ABBREVIATIONS. PDA, patent ductus arteriosus; hsPDA; hemodynamically significant patent ductus arteriosus; BNP, B-type natriuretic peptide; sPDA, symptomatic patent ductus arteriosus; LA/AO, a ratio of left atrium to the aortic root diameter; DFLPA, diastolic flow velocity of the left pulmonary artery; ROC, receiver operator characteristic; asPDA, asymptomatic patent ductus arteriosus. R apidly and accurately determining the indications of therapeutic closure of a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is extremely important. [1][2][3] The currently used tools, such as the clinical findings, which include heart failure and the typical echocardiographic features of hsPD...

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Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care

Cited by 73 publications

References 25 publications

B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure

Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants

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