Imaging and Diagnostic Testing
Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction

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Abstract

Background Although echocardiography is an important tool for making the diagnosis of left ventricular (LV) dysfunction, the cost of this procedure limits its use as a routine screening tool for this purpose. Brain natriuretic peptide (BNP) accurately reflects ventricular pressure, and preliminary studies have found it to be highly sensitive and highly specific in diagnosing congestive heart failure in the emergency department. We hypothesized that BNP might therefore be useful as a screening tool before echocardiography in patients with suspected LV dysfunction. Methods Subjects included patients referred for echocardiography to evaluate the presence or absence of LV dysfunction. Patients with known LV dysfunction were excluded from analysis. BNP was measured by a point-of-care immunoassay (Biosite Diagnostics, San Diego, Calif). The results of BNP levels were blinded from cardiologists making the assessment of LV function. Patients were divided into those with normal ventricular function, abnormal systolic ventricular function, abnormal diastolic function, and evidence of both systolic and diastolic dysfunction. Results Two hundred patients in whom LV function was unknown were studied. In the 105 patients (53%) whose ventricular function was subsequently determined to be normal by echocardiography, BNP levels averaged 37 ± 6 pg/mL. This was significantly less than in those patients with either ultimate diastolic dysfunction (BNP 391 ± 89 pg/mL (P <.001) or systolic dysfunction (BNP 572 ± 115 pg/mL (P <.001). A receiver-operator characteristic curve showing the sensitivity and specificity of BNP against the echocardiography diagnosis revealed the area under the curve (accuracy) was 0.95. At a BNP level of 75 pg/mL was 98% specific for detecting the presence or absence of LV dysfunction by echocardiography. Conclusions A simple, rapid test for BNP, which can be performed at the bedside or in the clinic, can reliably predict the presence or absence of LV dysfunction on echocardiogram. The data indicate that BNP may be an excellent screening tool for LV dysfunction and may, in fact, preclude the need for echocardiography in many patients. (Am Heart J 2001; 141:367-74.)

Section snippets

Study population

The study was approved by the University of California Institutional Review Board and conducted at the San Diego Veteran's Health care System between June and October 1999. Two hundred consecutive patients referred for echocardiography to evaluate LV function and consented to be studied were included from a total of 262 patients referred for LV function during this time period. The 62 patients with known LV dysfunction were excluded from analysis. Patients referred for echocardiography to

Results

The characteristics of the 200 patients are shown in Table I.

. Patient characteristics

No.200
Age (y)65.32 ± 0.9
Sex (male/female)189/11
All normal53%
All abnormal48%
History of hypertension65%
History of diabetes34%
History of coronary artery disease46%
History of shortness of breath52%
History of edema28%

Characteristics of all 200 patients recruited into the study. History included presence or absence of diabetes, hypertension, or coronary artery disease and symptoms included presence or absence of

Discussion

Early detection of LV dysfunction enables administration of treatment that can improve survival and increase well-being.2, 6 But ventricular dysfunction may be difficult to diagnose because patients may be asymptomatic, and abnormal findings on physical examination are often absent.3, 4 Echocardiography, the most commonly used method to diagnose LV dysfunction, is one of the fastest growing procedures in cardiology.25 However, both the limited availability of echocardiography in community

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    Reprint requests: Alan Maisel, MD, VAMC Cardiology 111-A, 3350 La Jolla Village Dr, San Diego, CA 92161. E-mail: [email protected]

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