Heart 2001;86:21-26 ( July )

Cardiovascular medicine

Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population T A McDonagh^a, A D Cunningham^b, C E Morrison^c, J J V McMurray^b, I Ford^d, J J Morton^b, H J Dargie^b

^a Department of Medical Cardiology, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK, ^b Department of Cardiology, University of Glasgow, Western Infirmary, ^c Greater Glasgow Health Board, ^d Robertson Centre for Biostatistics, University of Glasgow

Correspondence to: Dr McDonagh t.mcdonagh{at}bio.gla.ac.uk

Accepted 18 January 2001

OBJECTIVETo report the mortality of left ventricular systolic dysfunction (LVD), assessed objectively by echocardiography, and its association with natriuretic peptide hormones in a random sample of 1640 men and women aged 25-74 years from a geographical, urban population.
METHODSLeft ventricular function was measured by echocardiography in 1640 attendees studied in 1992-3. LVD was defined as a left ventricular ejection fraction (LVEF)  30%. Plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP) were measured by standard radioimmunoassays. Mortality was documented at four years.
RESULTSThe four year all cause mortality rate in the whole cohort was 4.9% (80 deaths). It was 21% (nine deaths) in those with an LVEF  30% and 4% in those whose LVEF was > 30% (p < 0.001). The median (interquartile range) BNP concentration in those who died was 16.9 pg/ml (8.8-27) and 7.8 pg/ml (3.4-13) in survivors (p < 0.0001). Similarly, N-ANP had a median concentration of 2.35 ng/ml (1.32-3.36) in those with a fatal outcome and 1.27 ng/ml (0.9-2.0) in those alive at four years (p < 0.0001). Subjects with an LVEF  40% also had a significant mortality rate of 17% if they also had a BNP concentration  17.9 pg/ml compared with 6.8% if their BNP was below this concentration (p = 0.013). Multivariate analysis revealed the independent predictors of four year all cause mortality to be increasing age (p < 0.001), a BNP concentration  17.9 pg/ml (p = 0.006), the presence of ischaemic heart disease (p = 0.03), and male sex (p = 0.04).
CONCLUSIONSLVD is associated with a considerable mortality rate in this population. BNP also independently predicts outcome. In addition to its role as a diagnostic aid in chronic heart failure and LVD, it provides prognostic information and clarifies the meaning of a given degree of LVD.


Keywords: epidemiology; left ventricular dysfunction; natriuretic peptides

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© 2001 by Heart
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