title: N-terminal brain natriuretic peptide as a screening tool for heart failure in the pacemaker population.
abstract: OBJECTIVE
  Assessment of N-terminal brain natriuretic peptide (NT-BNP) as a screening tool for heart failure in patients with a permanent pacemaker.
  
  
  RESULTS
  Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT-BNP. Analysis was performed on 261 patients (132 DDD, 121 VVI, eight others), mean age 73+/-12 years, range 34-99 years. Seventy two subjects (27%) had heart failure as defined by left ventricular ejection fraction (LVEF) <or=40% and symptoms of heart failure (NYHA class II, III, or IV). Screening with NT-BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve (AUC) 0.76, P<0.001, 95% CI 0.69-0.83]. This increased in subjects with a DDD type pacemaker (sensitivity 80%, specificity 66%, AUC=0.8, CI 0.7-0.90) and reduced in subjects with a VVI type pacemaker (sensitivity 66%, specificity 61%, AUC 0.68 CI 0.57-0.78).
  
  
  CONCLUSIONS
  Symptoms of heart failure are common in patients with pacemakers. Screening with NT-BNP is feasible and assists in the detection of important cardiac co-morbidity, particularly in patients with a DDD type pacemaker.
authors.affiliation: Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, Cottingham, East Yorkshire, UK. simonthackray@hotmail.com
authors.forename: Simon D R
authors.initials: SD
authors.lastname: Thackray
authors.forename: Klaus
authors.initials: K
authors.lastname: Witte
authors.forename: Justin
authors.initials: J
authors.lastname: Ghosh
authors.forename: Nikolay
authors.initials: N
authors.lastname: Nikitin
authors.forename: Anne
authors.initials: A
authors.lastname: Anderson
authors.forename: Alan
authors.initials: A
authors.lastname: Rigby
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D005189:False Positive Reactions; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain