title: Rapid brain natriuretic peptide test and Doppler echocardiography for early diagnosis of mild heart failure.
abstract: BACKGROUND
  The early identification of patients at risk for the development of clinical heart failure (HF) is a new challenge in an effort to improve outcomes.
  
  
  METHODS
  We prospectively evaluated whether the combination of brain natriuretic peptide (BNP) measurements (Triage BNP test, Biosite Diagnostics) and echocardiography would effectively stratify patients with new symptoms in a cost-effective HF program aimed at early diagnosis of mild HF. A total of 252 patients were referred by 100 general practitioners.
  
  
  RESULTS
  Among the study population, the median BNP value was 78 ng/L (range, 5-1491 ng/L). BNP concentrations were lower among patients without heart disease [median 15 ng/L (range, 5-167 ng/L); n = 96] than among patients with confirmed HF [median, 165 ng/L (22-1491 ng/L); n = 157; Mann-Whitney U-test, 12.3; P <0.001]. Patients were grouped into diastolic dysfunction [BNP, 195 (223) ng/L], systolic dysfunction [BNP, 290 (394) ng/L], and both systolic and diastolic dysfunction [BNP, 776 (506) ng/L]. In this model, a cutoff value of 50 ng/L BNP increases the diagnostic accuracy in predicting mild HF, avoiding 41 echocardiograms per 100 patients studied, with a net saving of 14% of total costs.
  
  
  CONCLUSIONS
  Blood BNP concentrations, in a cost effective targeted screening, can play an important role in diagnosing mild HF and stratifying patients into risk groups of cardiac dysfunction.
authors.affiliation: Heart Failure Unit and Department of Cardiology, Santo Spirito Hospital, Rome, Italy. naspromonte@yahoo.it
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromonte
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ceci
authors.forename: Antonella
authors.initials: A
authors.lastname: Chiera
authors.forename: Claudio
authors.initials: C
authors.lastname: Coletta
authors.forename: Alessandra
authors.initials: A
authors.lastname: D'Eri
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Prospero
authors.initials: P
authors.lastname: Giovinazzo
authors.forename: Loredano
authors.initials: L
authors.lastname: Milani
authors.forename: Federica
authors.initials: F
authors.lastname: Noventa
authors.forename: Angela Beatrice
authors.initials: AB
authors.lastname: Scardovi
authors.forename: Augusto
authors.initials: A
authors.lastname: Sestili
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016507:Cardiology Service, Hospital; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain