Elsevier

Journal of Cardiac Failure

Volume 6, Issue 3, September 2000, Pages 194-200
Journal of Cardiac Failure

Clinical Investigations
Clinical criteria and biochemical markers for the detection of systolic dysfunction*,**

https://doi.org/10.1054/jcaf.2000.9676Get rights and content

Abstract

Background: This study was designed to assess the use of clinical criteria and biochemical testing to detect systolic dysfunction. Our goal is to develop strategies that may enhance the detection and treatment of patients with early ventricular dysfunction while reducing the use of echocardiography. Methods and Results: We compared the predictive characteristics of the plasma brain natriuretic peptide (BNP) concentration with that of a 5-point clinical score derived from elements of the history, electrocardiogram, and chest radiograph in outpatients (n = 466) referred for echocardiography because of symptoms of heart failure or risk factors for systolic dysfunction. Systolic dysfunction was defined as an ejection fraction (EF) less than 45% and was present in 10.9% of patients. By receiver operating characteristic analysis, BNP was sensitive and specific for the detection of systolic dysfunction, with an area under the receiver operating characteristic curve for the detection of EF less than 45% of 0.79. The BNP assay was abnormal in 41% of patients and identified a group with a high prevalence of systolic dysfunction (21% with an EF less than 45%), whereas a normal BNP value identified a group with a low prevalence of systolic dysfunction (4% with an EF less than 45%). The clinical score was positive in 43% of the population and identified a group with a high prevalence of systolic dysfunction (24% with an EF less than 45%). A normal score identified a group with a low prevalence of systolic dysfunction (1% with an EF less than 45%). Conclusion: This study supports previous studies, which showed that BNP assay predicts systolic dysfunction with acceptable sensitivity and specificity, and it underscores the effectiveness of additional readily available clinical criteria. Both of these strategies should be considered in screening for left ventricular dysfunction in populations at risk while limiting expensive cardiac imaging modalities.

Section snippets

Study population

The study population comprised 466 consecutive outpatients referred to the Mayo Clinic Echocardiography Laboratory for assessment of systolic function. The reason for referral was identified, and only patients with a primary indication to assess ventricular function were included. The reason for referral was further classified as 1) symptoms of heart failure that included 1 or more of the following: dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema, or fatigue; or 2) risk

Patient characteristics

Table 1 reports the clinical characteristics of the patients.

. Clinical Characteristics of the Patient Population

CharacteristicTotal (n = 466)
Median age (yr)65
Male, % of patients55
Reason for echocardiographic referral, % of patients
 Symptoms of CHF33
 Risk factors for LV dysfunction67
Past history, % of patients
 Hypertension54
 Coronary artery disease26
 Myocardial infarction10
 Diabetes mellitus15
EF <45%, no. of patients (%)51(10.9)
Medications, % of patients
 ACE inhibitors20
 β-Blockers21
 Diuretics30
 Nitrates10
 

Discussion

We investigated the ability of clinical data and plasma BNP concentration to detect systolic dysfunction in patients being referred to echocardiography to assess systolic function because of symptoms of congestive heart failure or risk factors for systolic dysfunction at a large outpatient echocardiographic laboratory. In this population, the prevalence of a reduced EF (less than 45%) was 10.9%. Patients could be divided into high- and low-risk groups based on either a simple clinical score

Acknowledgements

Dr. Yamamoto was supported by the Fellowship of the Uehara Memorial Foundation.

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  • Cited by (0)

    *

    Supported in part by grants from the Joseph P. and Jeanne M. Sullivan Foundation, Chicago, Illinois; the Miami Heart Research Institute, Miami, Florida; the National Heart, Lung, and Blood Institute, Bethesda, Maryland (HL-033643); and the Mayo Foundation, Rochester, Minnesota.

    **

    Reprint requests: Margaret M. Redfield, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.

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