title: Utility of the amino-terminal fragment of pro-brain natriuretic peptide in plasma for the evaluation of cardiac dysfunction in elderly patients in primary health care.
abstract: BACKGROUND
  The aims of this study were to measure the N-terminal fragment of pro-brain natriuretic peptide (proBNP) in plasma in medical conditions commonly found in primary care and to evaluate the utility of these measurements in identifying impaired cardiac function in elderly patients with symptoms associated with heart failure.
  
  
  METHODS
  We studied 415 patients (221 men and 194 women; mean age, 72 years) who had contacted a primary healthcare center for dyspnea, fatigue, and/or peripheral edema. One cardiologist evaluated the patients in terms of history, physical examination, functional capacity, electrocardiography, and suspicion of heart failure. Plasma N-terminal proBNP was measured by an in-house RIA. An ejection fraction < or =40% by Doppler echocardiography was regarded as reduced cardiac function. Abnormal diastolic function was defined as an abnormal mitral inflow defined as reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio), or as abnormal pulmonary venous flow pattern.
  
  
  RESULTS
  Patients with impaired functional capacity, impaired systolic function, and/or impaired renal function had significantly increased N-terminal proBNP concentrations. By multiple regression analysis, N-terminal proBNP concentrations were also influenced by ischemic heart disease, cardiac enlargement, and certain medications but not by increased creatinine. No gender differences were observed. Patients with isolated diastolic dysfunction attributable to relaxation abnormalities had lower concentrations than those with normal cardiac function, whereas those with pseudonormal E/A ratios or restrictive filling patterns had higher concentrations.
  
  
  CONCLUSIONS
  Plasma N-terminal proBNP concentrations increase as a result of impaired systolic function, age, impaired renal function, cardiac ischemia and enlargement, and certain medications. Values are high in diastolic dysfunction with pseudonormal patterns, but not in patients with relaxation abnormalities. An increase in plasma N-terminal proBNP might be an earlier sign of abnormal cardiac function than abnormalities identified by currently used echocardiographic measurements.
authors.affiliation: Department of Cardiology, Linköping University Hospital, SE-581 85 Linköping, Sweden. urban.alehagen@ihs.liu.se
authors.forename: Urban
authors.initials: U
authors.lastname: Alehagen
authors.forename: Göran
authors.initials: G
authors.lastname: Lindstedt
authors.forename: Henry
authors.initials: H
authors.lastname: Eriksson
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006332:Cardiomegaly / Q000097:blood / Q000000981:diagnostic imaging; D003971:Diastole; D015150:Echocardiography, Doppler; D004487:Edema / Q000097:blood / Q000175:diagnosis; D005194:Family Practice; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D011859:Radiography; D013599:Systole; D018754:Ventricular Dysfunction / Q000097:blood / Q000175:diagnosis
chemical_list: D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain