title: Early diagnosis of congestive heart failure: clinical utility of B-type natriuretic peptide testing associated with Doppler echocardiography.
abstract: OBJECTIVE
  B-type natriuretic peptide (BNP) has emerged as an important diagnostic serum marker of congestive heart failure (CHF). The aim of this study was to evaluate whether BNP measurement associated with echocardiography could effectively stratify patients with new symptoms as part of a cost-effective heart failure programme based on cooperation between hospital cardiologists and primary care physicians.
  
  
  METHODS
  Patients were referred to the cardiology clinic by general practitioners in case of clinical suspect of CHF. All patients underwent clinical examination, transthoracic echocardiography and plasma determination of BNP. Systolic dysfunction was defined as a left ventricular ejection fraction < 45%; diastolic dysfunction was defined as a preserved systolic function with signs of diastolic impairment.
  
  
  RESULTS
  Three hundred and fifty-seven subjects were examined (50% males, mean age 73 years). BNP concentration was 469 +/- 505 pg/ml in the 240 patients diagnosed with CHF, compared with 43 +/- 105 pg/ml in the 117 patients without CHF (P = 0.001). CHF patients were grouped into those with diastolic dysfunction (n = 110; BNP 373 +/- 335 pg/ml), systolic dysfunction (n = 108; BNP 550 +/- 602 pg/ml), and both systolic and diastolic dysfunction (n = 22; BNP 919 +/- 604 pg/ml). At receiver operating characteristic analysis, the optimal BNP cut-off level for diagnosing CHF was 80 pg/ml (sensitivity 84%, specificity 91%). According to cost analysis, this cut-off level might provide a cost saving of 31% without affecting diagnostic accuracy.
  
  
  CONCLUSIONS
  In patients referred by general practitioners for suspected CHF, plasma BNP levels might help to stratify subjects into different groups of cardiac dysfunction.
authors.affiliation: Heart Failure Unit, Department of Cardiology, Santo Spirito Hospital, Rome, Italy. naspromonte@yahoo.it
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Angela Beatrice
authors.initials: AB
authors.lastname: Scardovi
authors.forename: Claudio
authors.initials: C
authors.lastname: Coletta
authors.forename: Alessandra
authors.initials: A
authors.lastname: D'Eri
authors.forename: Prospero
authors.initials: P
authors.lastname: Giovinazzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carunchio
authors.forename: Antonella
authors.initials: A
authors.lastname: Chiera
authors.forename: Renato
authors.initials: R
authors.lastname: Fanelli
authors.forename: Tiziana
authors.initials: T
authors.lastname: Di Giacomo
authors.forename: Roberto
authors.initials: R
authors.lastname: Ricci
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ceci
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D013902:Radiography, Thoracic; D012017:Referral and Consultation; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain