Published online before print June 7, 2004, doi: 10.1161/01.CIR.0000130845.38133.8F
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(Circulation. 2004;109:3176-3181.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Plasma Brain Natriuretic Peptide to Detect Preclinical Ventricular Systolic or Diastolic Dysfunction
A Community-Based Study
From the Division of Cardiovascular Diseases and Sections of Health Science Research (S.R.J.) and Biostatistics (D.W.M., K.R.B.), Mayo Clinic and Foundation, Rochester, Minn.
Correspondence to Margaret M. Redfield, MD, Guggenheim 9, Mayo Clinic, 200 First St, Southwest, Rochester, MN 55905. E-mail redfield.margaret{at}mayo.edu
Received November 24, 2003; revision received March 9, 2004; accepted March 15, 2004.
Background— Preclinical systolic or diastolic dysfunction is associated with increased morbidity and mortality. We postulated that plasma brain natriuretic peptide (BNP) might serve as a biomarker for preclinical ventricular dysfunction (PCVD) but that the discriminatory values for BNP may vary with age and sex.
Methods and Results— We measured BNP, systolic and diastolic ventricular function, and clinical parameters in 2042 randomly selected residents of Olmsted County, Minn, aged 45 years or older. For preclinical systolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with more severe (0.82 to 0.92) than any (0.51 to 0.74) systolic dysfunction and were similar in men and women and in younger and older persons. For preclinical diastolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with moderate-to-severe (0.74 to 0.79) than any (0.52 to 0.68) diastolic dysfunction and were similar regardless of age or sex. Optimal discriminatory values of BNP varied with age and sex. Considering the prevalence of preclinical systolic or diastolic dysfunction and the predictive characteristics observed, using BNP to screen for PCVD would necessitate echo in 10% to 40% of those screened, with most confirmatory echocardiograms being negative, and would miss 10% to 60% of those affected.
Conclusions— BNP is a suboptimal screening test for PCVD in the population.
Key Words: natriuretic peptides • ventricular dysfunction • diastole • systole • diagnosis
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