Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population

Abstract

Background: Conflict exists regarding the usefulness of measuring plasma B type natriuretic peptide (BNP) concentrations for identifying impaired left ventricular (LV) systolic function during mass screening. Various cardiac abnormalities, regardless of degree of LV dysfunction, are prone to carry a high risk of cardiovascular events. Objective: To examine the validity of plasma BNP measurement for detection of various cardiac abnormalities in a population with a low prevalence of coronary heart disease and LV systolic dysfunction. Design and setting: Participants in this cross sectional study attended a health screening programme in Iwate, northern Japan. Plasma BNP concentrations were determined in 1098 consecutive subjects (mean age 56 years) by direct radioimmunoassay. All subjects underwent multiphasic health checkups including physical examination, ECG, chest radiography, and transthoracic echocardiography. Results: Conventional diagnostic methods showed 39 subjects to have a wide range of cardiac abnormalities: lone atrial fibrillation or flutter in 11; previous myocardial infarction in seven; valvar heart disease in seven; hypertensive heart disease in six; cardiomyopathy in six; atrial septal defect in one; and cor pulmonale in one. No subjects had a low LV ejection fraction (< 40%). To assess the utility of plasma BNP measurement for identification of such patients, receiver operating characteristic analysis was performed. The optimal threshold for identification was a BNP concentration of 50 pg/ml with sensitivity of 89.7% and specificity of 95.7%. The area under the receiver operating characteristic curve was 0.970. The positive and negative predictive values at the cutoff level were 44.3% and 99.6%, respectively. Conclusion: Measurement of plasma BNP concentration is a very efficient and cost effective mass screening technique for identifying patients with various cardiac abnormalities regardless of aetiology and degree of LV systolic dysfunction that can potentially develop into obvious heart failure and carry a high risk of a cardiovascular event.

Soluble Fms-like Tyrosine Kinase 1 Is a Novel Predictor of Brain Natriuretic Peptide Elevation

“…19,23) Therefore, plasma BNP levels may be a potential screening marker for identifying individuals with asymptomatic mild heart failure as well as those at high risk for moderateto-severe heart failure because of various forms of structural heart disease. 24) The relationship between angiogenesis biomarkers and BNP levels has not been prospectively evaluated. In our study, 2.5 ± 3.3 1.6 ± 1.…”

NT‐proBNP is associated with mortality and adverse cardiac events in patients with atrial fibrillation presenting to the emergency department

“…It is known that plasma BNP can be elevated in subjects with subclinical structural heart disease. 35 We therefore speculate that the elevated levels of plasma BNP in the patients with worse outcomes denote mild structural heart disease such as subclinical cardiac dysfunction, including mildly elevated intracardiac pressure and volume and, possibly, myocardial ischemia. These individuals might be prone to be at risk for HF and coronary heart disease.…”

Comparison of Positive Cases for B-type Natriuretic Peptide and ECG Testing for Identification of Precursor Forms of Heart Failure in an Elderly Population

“…However, this value is comparable to that in our previous report conducted in a Japanese population participating in a multiphasic health examination programme. 13) As the predominant etiology in this instance was coronary heart disease, the low prevalence of left ventricular systolic dysfunction in this population may have been due to the low prevalence of coronary heart disease. Clinical Implications: The most prevalent precursors of CHF in the general population are hypertensive cardiac hypertrophy, coronary heart disease, and a combination of the two.…”

“…This was done because a previous study of ours using identical assay methodology showed that this was the most useful cutoff point for the detection of several types of structural cardiac disorder. 13) Another limitation of the present study was the possibility of bias in the selection of the subject population. However, the trends in the prevalence of hypertension, history of stroke, serum total cholesterol levels, and body mass index in the present cohort were similar to those reported in a randomly selected Japanese adult population.…”

“…13) Plasma BNP levels were measured by direct radioimmunoassay using monoclonal antibodies specific for human BNP (Shiono RIA BNP kit, Shionogi & Co., Ltd., Japan). While the blood samples for routine testing were being taken, an additional 2 mL sample of venous blood was collected into a test tube containing EDTA-2Na for plasma BNP measurement.…”