Rapid brain natriuretic peptide test and Doppler echocardiography for early diagnosis of mild heart failure.
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.
Aspromonte
Nadia
N
Heart Failure Unit and Department of Cardiology, Santo Spirito Hospital, Rome, Italy. naspromonte@yahoo.it
Ceci
Vincenzo
V
Chiera
Antonella
A
Coletta
Claudio
C
D'Eri
Alessandra
A
Feola
Mauro
M
Giovinazzo
Prospero
P
Milani
Loredano
L
Noventa
Federica
F
Scardovi
Angela Beatrice
AB
Sestili
Augusto
A
Valle
Roberto
R
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
D020097:Natriuretic Peptide, Brain