Abstract 2094: B-type Natriuretic Peptide Is Useful In Detecting Asymptomatic Left Ventricular Dysfunction in Low-Income, Uninsured Hispanic Patients
BACKGROUND: Heart failure (HF) is a significant public health problem, particularly in low income Hispanics with multiple cardiovascular risk factors (CRFs). The effectiveness of B-type natriuretic peptide (BNP) screening for identification of asymptomatic left ventricular dysfunction (ALVD) in Hispanics with multiple CRFs has not been tested. The purposes of this pilot study were to: 1) describe BNP levels in low-income, uninsured asymptomatic Hispanics with multiple CRFs; and 2) determine the correlation between BNP levels and echocardiography for identifying ALVD in high risk Hispanics.
METHODS: A sample of 53 asymptomatic patients (age 55±10 years, 83% non-White, 64% female) was seen in a county facility. Patients were uninsured and CRFs were common (74% hypertension, 51% diabetes, 47% metabolic syndrome, mean BMI 31±9). All underwent BNP testing and echocardiograms (ECHO) and were grouped based on left ventricular (LV) function. Chi-square and t-tests were used to compare groups. Univariate, multivariate, and logistic regression analyses were used to evaluate the ability of BNP to identify ALVD. Receiver-operating characteristic plots were conducted to identify the optimal cut-off values for the diagnosis of ALVD. A value of p<0.05 was set as the significance threshold.
RESULTS: Thirty patients (57%) were diagnosed with ALVD by ECHO: 21(40%) had diastolic dysfunction, 9 (17%) had systolic dysfunction. BNP was lower among those with normal LV function (29.6 ± 24 pg/mL), compared to those with diastolic dysfunction (80.2 ± 69 pg/mL, p=0.01) and systolic dysfunction (337.1 ± 374 pg/mL, p=0.009). Subjects with BNP ≥50 pg/mL were 5.75 times more likely to exhibit diastolic dysfunction than those with lower BNP levels (95% CI 1.29 –25.51; p=0.01). Subjects with BNP ≥100 pg/mL were 7.80 times more likely to have systolic dysfunction (OR=7.8, 95% CI 1.60 –37.14; p<0.005). With BNP cutpoint of 50 pg/mL, area under the curve was 0.82 (95% CI 0.63 to 1.00) with a sensitivity of 88% and specificity of 67%.
CONCLUSIONS: BNP is useful in detecting ALVD in high risk Hispanics. Elevated BNP levels should prompt clinicians to initiate further diagnostic treatment that may lead to early intervention and improved survival.