title: Population-based detection of systolic and diastolic dysfunction with amino-terminal pro-B-type natriuretic peptide.
abstract: BACKGROUND
  There is limited information regarding the clinical utility of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) for the detection of left ventricular (LV) dysfunction in the community. We evaluated predictors of circulating NT-proBNP levels and determined the utility of NT-proBNP to detect systolic and diastolic LV dysfunction in older adults.
  
  
  METHODS
  A population-based sample of 1229 older adults (mean age 69.4 years, 50.1% women) underwent echocardiographic assessment of cardiac structure and function and measurement of circulating NT-proBNP levels.
  
  
  RESULTS
  Predictors of NT-proBNP included age, female sex, body mass index, and cardiorenal parameters (diastolic dysfunction [DD] severity; LV mass and left atrial volume; right ventricular overload; decreasing ejection fraction [EF] and creatinine clearance). The performance of NT-proBNP to detect any degree of LV dysfunction, including mild DD, was poor (area under the curve 0.56-0.66). In contrast, the performance of NT-proBNP for the detection of EF < or = 40% and moderate-severe DD was strong with area under the curve of > 0.90 regardless of age and sex; history of hypertension, diabetes, coronary artery disease; or body mass category. The ability of NT-proBNP to detect EF < or = 40% and/or moderate-severe DD was optimized by using age/sex-specific limits. Of "false-positive" tests, 88% (124/141) were explained after considering cardiorenal determinants of NT-proBNP levels.
  
  
  CONCLUSIONS
  Amino-terminal pro-B-type natriuretic peptide is a suboptimal marker of mild LV dysfunction, but performs strongly as a marker of EF < or = 40% and/or moderate-severe DD in the community. Most subjects with a positive NT-proBNP test, using age/sex-specific cutoffs, had prognostically significant abnormalities of cardiac structure or function.
authors.affiliation: The Department of Cardiology, The Canberra Hospital, Canberra, Australia.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Abhayaratna
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.forename: Niels G
authors.initials: NG
authors.lastname: Becker
authors.forename: Ian M
authors.initials: IM
authors.lastname: Jeffery
authors.forename: Darryl A
authors.initials: DA
authors.lastname: McGill
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Smith
mesh_terms: D000368:Aged; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain