title: The NT-proBNP assay identifies very elderly nursing home residents suffering from pre-clinical heart failure.
abstract: BACKGROUND
  Little is known about the prevalence of heart failure among very old people, although hospitalisation rates for chronic heart failure are very high. Recently, brain natriuretic peptides have emerged as important diagnostic and prognostic serum markers for congestive heart failure.
  
  
  OBJECTIVE
  The main purpose of our study was to determine whether there is a cut-off for NT-proBNP for detecting the echocardiographic features of left ventricular systolic and/or diastolic dysfunction and clinical heart failure among old people living in nursing homes. Secondarily, we investigated the medium-term prognostic power of the neurohormone levels.
  
  
  METHODS
  We screened 101 old people (80% females, aged 84+/-9 years) from two nursing homes. We prospectively evaluated whether we could effectively stratify patients using a combination of (1) restrictive clinical criteria, (2) NT-proBNP measurements (Elecsys System, Roche Diagnostics) and (3) echocardiography for all patients.
  
  
  RESULTS
  Forty-two percent of the subjects had left ventricular dysfunction: 11% systolic, 23% diastolic and 8% both systolic and diastolic. The mean NT-proBNP concentration was 2806+/-7028 pg/ml in the 42 patients with left ventricular systolic and/or diastolic dysfunction, compared with 365+/-456 pg/ml in the 59 patients with normal left ventricular function (p<0.01, Z=-4.8 Mann-Whitney U test). The neurohormone proved to be a good predictor of events within 6 months [area under the receiver-operated curve (ROC)=0.79].
  
  
  CONCLUSIONS
  Blood NT-proBNP concentrations can play an important role in stratifying old people into left ventricular dysfunction risk groups. The neurohormone is an independent marker for death or admission for heart failure in the medium term.
authors.affiliation: Heart Failure Unit, Cardiology Department, Ospedale Civile, Via Sauro, 30027, San Dona' di Piave, Italy. robertovalle@libero.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Sabrina
authors.initials: S
authors.lastname: Barro
authors.forename: Cristina
authors.initials: C
authors.lastname: Canali
authors.forename: Emanuele
authors.initials: E
authors.lastname: Carbonieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ceci
authors.forename: Maura
authors.initials: M
authors.lastname: Chinellato
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gallo
authors.forename: Prospero
authors.initials: P
authors.lastname: Giovinazzo
authors.forename: Roberto
authors.initials: R
authors.lastname: Ricci
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain