title: Electrocardiogram and B-type natriuretic peptide as screening tools for left ventricular systolic dysfunction in a population-based sample of 75-year-old men and women.
abstract: BACKGROUND
  Plasma concentration of B-type natriuretic peptide (BNP) has been suggested as a powerful screening tool for left ventricular systolic dysfunction. However, there are reports indicating that the 12-lead electrocardiogram (ECG) could be just as powerful. We aimed to evaluate the 12-lead ECG and BNP as screening tools for left ventricular systolic dysfunction in an elderly, unselected population.
  
  
  METHODS
  In a randomly selected population-based sample of 75-year-old men and women (n = 407), diagnostic characteristics were evaluated for the ECG and plasma concentration of BNP to detect left ventricular systolic dysfunction.
  
  
  RESULTS
  Sensitivity, specificity, and negative and positive predictive values for the ECG to detect left ventricular systolic dysfunction were 96%, 79%, 100%, and 26%, respectively. The corresponding values for the BNP (cut-off value 28 pg/mL) were 93%, 55%, 99%, and 13%. In participants without major abnormalities in the ECG, left ventricular systolic dysfunction was found in <1% (1/302), irrespective of BNP concentrations. In participants with abnormal ECGs, systolic dysfunction was more prevalent in persons with abnormal BNP concentrations than in those with normal concentrations (35% vs 3%, difference 32%, 95%CI for the difference 16%-44%)
  
  
  CONCLUSIONS
  In 75-year-old subjects both the ECG and the plasma concentration of BNP are highly efficient in excluding left ventricular systolic dysfunction. However, compared with the BNP, the ECG yields a lower number of false positive cases. In screening for left ventricular systolic dysfunction, the BNP has a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.
authors.affiliation: Department of Clinical Physiology, Central Hospital, Västerås, Sweden. par.o.hedberg@ltvastmanland.se
authors.forename: Pär
authors.initials: P
authors.lastname: Hedberg
authors.forename: Ingemar
authors.initials: I
authors.lastname: Lönnberg
authors.forename: Tommy
authors.initials: T
authors.lastname: Jonason
authors.forename: Göran
authors.initials: G
authors.lastname: Nilsson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pehrsson
authors.forename: Ivar
authors.initials: I
authors.lastname: Ringqvist
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004562:Electrocardiography; D005189:False Positive Reactions; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D020097:Natriuretic Peptide, Brain