BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is useful for diagnosing acute decompensated heart failure. Whether NT-proBNP can be used to detect ventricular dysfunction in patients with stable coronary heart disease (CHD) and no history of heart failure is unknown. METHODS: We measured NT-proBNP levels and performed transthoracic echocardiography in 815 participants from the Heart and Soul Study, who had stable CHD and no history of heart failure. We hypothesized that NT-proBNP concentrations lower than 100 pg/mL would rule out ventricular dysfunction and concentrations higher than 500 pg/mL would identify ventricular dysfunction. We calculated sensitivities, specificities, likelihood ratios, and areas under the receiver operating characteristic curves for NT-proBNP as a case-finding instrument for systolic and diastolic dysfunction. RESULTS: Of the 815 participants with no history of heart failure, 68 (8%) had systolic dysfunction defined as a left ventricular ejection fraction of 50% or lower. Of the 730 participants for whom the presence or absence of diastolic dysfunction could be determined, 78 (11%) had diastolic dysfunction defined as a pseudonormal or restrictive filling pattern. The overall area under the receiver operating characteristic curve for detecting systolic or diastolic dysfunction was 0.78 (95% confidence interval, 0.74-0.82). Likelihood ratios were 0.28 for NT-proBNP concentrations lower than 100 pg/mL, 0.95 for concentrations between 100 and 500 pg/mL, and 4.1 for concentrations higher than 500 pg/mL. A test result lower than 100 pg/mL reduced the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 6%. A test result higher than 500 pg/mL increased the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 47%. A test result between 100 and 500 pg/mL did not change the probability of ventricular dysfunction. CONCLUSION: In patients with stable CHD and no history of heart failure, NT-proBNP levels lower than 100 pg/mL effectively rule out ventricular dysfunction, with a negative likelihood ratio of 0.28.
BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is useful for diagnosing acute decompensated heart failure. Whether NT-proBNP can be used to detect ventricular dysfunction in patients with stable coronary heart disease (CHD) and no history of heart failure is unknown. METHODS: We measured NT-proBNP levels and performed transthoracic echocardiography in 815 participants from the Heart and Soul Study, who had stable CHD and no history of heart failure. We hypothesized that NT-proBNP concentrations lower than 100 pg/mL would rule out ventricular dysfunction and concentrations higher than 500 pg/mL would identify ventricular dysfunction. We calculated sensitivities, specificities, likelihood ratios, and areas under the receiver operating characteristic curves for NT-proBNP as a case-finding instrument for systolic and diastolic dysfunction. RESULTS: Of the 815 participants with no history of heart failure, 68 (8%) had systolic dysfunction defined as a left ventricular ejection fraction of 50% or lower. Of the 730 participants for whom the presence or absence of diastolic dysfunction could be determined, 78 (11%) had diastolic dysfunction defined as a pseudonormal or restrictive filling pattern. The overall area under the receiver operating characteristic curve for detecting systolic or diastolic dysfunction was 0.78 (95% confidence interval, 0.74-0.82). Likelihood ratios were 0.28 for NT-proBNP concentrations lower than 100 pg/mL, 0.95 for concentrations between 100 and 500 pg/mL, and 4.1 for concentrations higher than 500 pg/mL. A test result lower than 100 pg/mL reduced the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 6%. A test result higher than 500 pg/mL increased the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 47%. A test result between 100 and 500 pg/mL did not change the probability of ventricular dysfunction. CONCLUSION: In patients with stable CHD and no history of heart failure, NT-proBNP levels lower than 100 pg/mL effectively rule out ventricular dysfunction, with a negative likelihood ratio of 0.28.
Authors: Frans H Rutten; Karel G M Moons; Maarten-Jan M Cramer; Diederick E Grobbee; Nicolaas P A Zuithoff; Jan-Willem J Lammers; Arno W Hoes Journal: BMJ Date: 2005-12-01
Authors: Aaron L Baggish; Uwe Siebert; John G Lainchbury; Renee Cameron; Saif Anwaruddin; Annabel Chen; Daniel G Krauser; Roderick Tung; David F Brown; A Mark Richards; James L Januzzi Journal: Am Heart J Date: 2006-01 Impact factor: 4.749
Authors: Lisa C Costello-Boerrigter; Guido Boerrigter; Margaret M Redfield; Richard J Rodeheffer; Lynn H Urban; Douglas W Mahoney; Steven J Jacobsen; Denise M Heublein; John C Burnett Journal: J Am Coll Cardiol Date: 2006-01-04 Impact factor: 24.094
Authors: Christopher Heeschen; Christian W Hamm; Veselin Mitrovic; Nicte-Ha Lantelme; Harvey D White Journal: Circulation Date: 2004-11-08 Impact factor: 29.690
Authors: Stefan K James; Bertil Lindahl; Jorik R Timmer; Jan Paul Ottervanger; Agneta Siegbahn; Mats Stridsberg; Paul Armstrong; Robert Califf; Lars Wallentin; Maarten L Simoons Journal: Am J Cardiol Date: 2005-11-21 Impact factor: 2.778
Authors: T Omland; A Aakvaag; V V Bonarjee; K Caidahl; R T Lie; D W Nilsen; J A Sundsfjord; K Dickstein Journal: Circulation Date: 1996-06-01 Impact factor: 29.690
Authors: Katarzyna Michaud; Marc Augsburger; Nicolas Donzé; Sara Sabatasso; Mohamed Faouzi; Marc Bollmann; Patrice Mangin Journal: Int J Legal Med Date: 2008-06-14 Impact factor: 2.686
Authors: Sharon Remmelzwaal; Adriana J van Ballegooijen; Linda J Schoonmade; Elisa Dal Canto; M Louis Handoko; Michiel T H M Henkens; Vanessa van Empel; Stephane R B Heymans; Joline W J Beulens Journal: BMC Med Date: 2020-10-30 Impact factor: 8.775