ArticlesBiochemical detection of left-ventricular systolic dysfunction
Introduction
Chronic heart failure (CHF) is a common, disabling disorder with high mortality, which is mainly attributable to left-ventricular systolic dysfunction.1, 2 CHF is often the endstage of progressive deterioration of left-ventricular function, which can remain asymptomatic for many years. The asymptomatic form of left-ventricular systolic dysfunction is as common as CHF.3 Treatment with inhibitors of angiotensin-converting enzyme decreases mortality and morbidity in patients with left-ventricular systolic dysfunction, with or without symptoms,4, 5 so detection of the disorder is worthwhile.
Detection of patients with symptomatic and asymptomatic left-ventricular systolic is crucial to decrease the substantial mortality and morbidity associated with CHF. However, the clinical diagnosis of CHF is unreliable6 and the asymptomatic precursor is clinically undetectable. Although population screening with echocardiography might provide a solution, it would not be cost-effective and a biochemical option would be more attractive.
C-terminal and N-terminal atrial natriuretic peptides (CT-ANP and NT-ANP) are mainly secreted by the atria in response to the stretch that occurs with the increased left-atrial pressure associated with CHF.7 The circulating concentrations of these peptides are raised in patients with symptomatic left-ventricular systolic dysfunction,8, 9 and the higher concentrations of NT-ANP reflect its longer half-life, which is due to lower renal clearance.10 Plasma concentrations of brain natriuretic peptide (BNP) mainly produced by the ventricles—are also raised in patients with symptomatic left-ventricular systolic dysfunction.11, 12 Moreover, plasma concentrations of both peptides are also raised in patients with asymptomatic left-ventricular systolic dysfunction.9, 12 Population screening for left-ventricular systolic dysfunction with natriuretic peptides has not been studied. We investigated the usefulness of NT-ANP and BNP in the identification of left-ventricular systolic dysfunction as a method of screening in the general population.
Section snippets
Methods
We randomly selected 2000 people aged 25–74 years from North Glasgow, UK, who had participated in the Third Glasgow MONICA risk factor survey in 1992. We used a two-stage random-sampling procedure. First, we randomly selected 30 family physicians from the 210 in the area. Second, we randomly selected patients of both sexes in 10-year age-groups between 25 and 74 years, in proportion to the age and sex distribution of the doctor's list of patients. We sent questionnaires to all patients; we
Results
Table 1 shows the characteristics of the study population. 1252 participants had an analysable echocardiogram, a completed questionnaire, an electrocardiogram, and an available blood sample.
37 participants (3·0%) had left-ventricular systolic dysfunction (left-ventricular ejection fraction ⩽30%); the impairment was symptomatic (cardiac dyspnoea or loop diuretic treatment) in 18 and asymptomatic in 19.
The median concentration of NT-ANP was significantly higher in participants with
Discussion
We have confirmed that BNP and NT-ANP are raised in people with left-ventricular systolic dysfunction, whether symptomatic or asymptomatic. Raised concentrations of BNP and NT-ANP have been reported previously in studies of patients with left-ventricular systolic dysfunction, especially previous myocardial infarction. However, we have now shown that people with asymptomatic left-ventricular systolic dysfunction, sampled from the general population have high circulating concentrations of
References (26)
- et al.
Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population
Lancet
(1997) - et al.
Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction
Lancet
(1993) - et al.
Plasma brain natriuretic peptide as an indicator of angiotensin converting enzyme inhibition after myocardial infarction
Lancet
(1993) - et al.
The natural history of congestive heart failure
N Engl J Med
(1971) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
N Engl J Med
(1991)Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)
N Engl J Med
(1987)Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions
N Engl J Med
(1992)- et al.
Echocardiography for chronic heart failure in the community
Q J Med
(1993) - et al.
Secretion of atrial natriuretic factor (1–98) by primary cardiac myocytes
J Biol Chem
(1988) - et al.
Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure: a substudy of the Studies of Left Ventricular Dysfunction (SOLVD)
Circulation
(1990)
Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factor in man
J Clin Endocrinol Metab
Natriuretic peptide system in human heart failure
Circulation
Left ventricular volume from paired biplane ventriculography
Circulation
Cited by (917)
Natriuretic peptides in the detection of left ventricular dysfunction in a high risk population. A meta-analysis of diagnostic tests
2020, Revista Colombiana de Cardiologia