Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study.
OBJECTIVE
To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people.


METHODS
Observational study.


METHODS
General practice with four centres in Poole, Dorset.


METHODS
155 elderly patients aged 70 to 84 years.


METHODS
Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography.


RESULTS
The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%.


CONCLUSIONS
Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to "rule in" the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.
Smith
H
H
Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST. hes@soton.ac.uk
Pickering
R M
RM
Struthers
A
A
Simpson
I
I
Mant
D
D
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011863:Radioimmunoassay; D012680:Sensitivity and Specificity; D018754:Ventricular Dysfunction / Q000175:diagnosis*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain