title: Utility of N terminal pro brain natriuretic peptide in elderly patients.
abstract: OBJECTIVE
  To evaluate the utility of N terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic marker for diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders in patients over 75 years.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Outpatient echocardiography service in a district general hospital.
  
  
  METHODS
  100 consecutive patients.
  
  
  METHODS
  Sensitivity, specificity, positive predictive values, negative predictive values, and area under receiver operating characteristic curve for NT-proBNP assay in the diagnosis of left ventricular diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders.
  
  
  RESULTS
  For diagnosis of systolic dysfunction NT-proBNP level of 424 pg/ml had a sensitivity of 96%, specificity of 45%, positive predictive value of 36%, and negative predictive value of 96%. The area under the curve was 0.71 (95% confidence intervals: 0.69 to 0.89). In valve heart disease, level of 227 pg/ml had sensitivity of 91%, specificity of 43%, positive predictive value of 40%, and negative predictive value of 92%. Patients with diastolic dysfunction/failure had lower plasma concentrations.
  
  
  CONCLUSIONS
  This study showed that NT-proBNP had excellent negative predictive value for systolic dysfunction and significant valve disorders in very elderly patients. It increased significantly in systolic dysfunction, valve heart disease, and atrial fibrillation. NT-proBNP is not useful in the diagnosis of diastolic dysfunction or diastolic heart failure using standard echocardiography criteria.
authors.affiliation: Lister Hospital, Stevenage, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sivakumar
authors.forename: D
authors.initials: D
authors.lastname: Wellsted
authors.forename: K
authors.initials: K
authors.lastname: Parker
authors.forename: M
authors.initials: M
authors.lastname: Lynch
authors.forename: P
authors.initials: P
authors.lastname: Ghosh
authors.forename: S A
authors.initials: SA
authors.lastname: Khan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006349:Heart Valve Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain