title: Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population.
abstract: OBJECTIVE
  To report the mortality of left ventricular systolic dysfunction (LVD), assessed objectively by echocardiography, and its association with natriuretic peptide hormones in a random sample of 1640 men and women aged 25-74 years from a geographical, urban population.
  
  
  METHODS
  Left ventricular function was measured by echocardiography in 1640 attendees studied in 1992-3. LVD was defined as a left ventricular ejection fraction (LVEF) </= 30%. Plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP) were measured by standard radioimmunoassays. Mortality was documented at four years.
  
  
  RESULTS
  The four year all cause mortality rate in the whole cohort was 4.9% (80 deaths). It was 21% (nine deaths) in those with an LVEF </= 30% and 4% in those whose LVEF was > 30% (p < 0.001). The median (interquartile range) BNP concentration in those who died was 16.9 pg/ml (8.8-27) and 7.8 pg/ml (3.4-13) in survivors (p < 0.0001). Similarly, N-ANP had a median concentration of 2.35 ng/ml (1.32-3.36) in those with a fatal outcome and 1.27 ng/ml (0.9-2.0) in those alive at four years (p < 0.0001). Subjects with an LVEF </= 40% also had a significant mortality rate of 17% if they also had a BNP concentration >/= 17.9 pg/ml compared with 6.8% if their BNP was below this concentration (p = 0.013). Multivariate analysis revealed the independent predictors of four year all cause mortality to be increasing age (p < 0.001), a BNP concentration >/= 17.9 pg/ml (p = 0.006), the presence of ischaemic heart disease (p = 0.03), and male sex (p = 0.04).
  
  
  CONCLUSIONS
  LVD is associated with a considerable mortality rate in this population. BNP also independently predicts outcome. In addition to its role as a diagnostic aid in chronic heart failure and LVD, it provides prognostic information and clarifies the meaning of a given degree of LVD.
authors: Department of Medical Cardiology, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK. t.mcdonagh@bio.gla.ac.uk
authors: T A
authors: TA
authors: McDonagh
authors: A D
authors: AD
authors: Cunningham
authors: C E
authors: CE
authors: Morrison
authors: J J
authors: JJ
authors: McMurray
authors: I
authors: I
authors: Ford
authors: J J
authors: JJ
authors: Morton
authors: H J
authors: HJ
authors: Dargie
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D012044:Regression Analysis; D013599:Systole; D014505:Urban Population / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000401:mortality*
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor