title: [Screening for asymptomatic left ventricular systolic dysfunction in high-risk patients. Preliminary experience with a program based on the use of ECG and natriuretic peptide].
abstract: BACKGROUND
  Patients with asymptomatic left ventricular systolic dysfunction (ALVSD) have an increased risk of heart failure (HF) and a worse life expectancy. Since valuable therapies may prevent such dismal evolution, screening programs for ALVSD have recently been advocated to detect as early as possible such ominous condition. Echocardiography represents the gold standard for the assessment of ALVSD but its indiscriminate use in screening programs is impractical. Clinical multivariate risk assessment associated with ECG and serum brain natriuretic peptide (BNP) may be a feasible strategy to screen ALVSD. We prospectively sought to investigate the feasibility and effectiveness of a screening program for ALVSD based on ECG and BNP used in a hierarchical sequence in patients at high risk for HF.
  
  
  METHODS
  Patients > or =55 years old with > or =2 risk factors for HF or > or =70 years old with > or =1 risk factor for HF entered the study performing sequentially ECG, BNP and echocardiographic evaluation. ALVSD was defined as a left ventricular ejection fraction < or =50%.
  
  
  RESULTS
  Thirty-three of 122 enrolled patients (27%) had ALVSD. They were older, presented more frequently a history of chemotherapy exposure, had often bundle branch block and higher BNP levels. No patient without any major abnormalities (atrial fibrillation, left ventricular hypertrophy, STT alterations of ischemic/strain origin, pathologic Q wave, bundle branch block) on ECG (n=31, 24.4%) had ALVSD. Among the 91 patients with abnormal ECG, ALVSD was observed in 33 (36%). The area under the receiver operating characteristic curve to detect ALVSD by BNP was 0.86 (confidence interval 0.79-0.94, p<0.0001) and BNP values of > or =43 pg/ml showed a sensitivity and a specificity of 94% and 57%, respectively. The proposed screening program was able to identify 95% (31/33) of patients with ALVSD saving 53% of echocardiographic examinations with a substantial reduction of the costs to diagnose ALVSD.
  
  
  CONCLUSIONS
  Our prospective investigation confirms that ECG and BNP may be useful in detecting ALVSD in high-risk patients. A cost-effective screening program based on such simple and low-cost diagnostic tests might be employed for the prevention of HF in primary and secondary prevention programs in high-risk patients.
authors.affiliation: Dipartimento di Cardiologia, Ospedale San Martino, Belluno. gitarant@yahoo.com
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Frigo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Soravia
authors.forename: Renato
authors.initials: R
authors.lastname: Tessier
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Catania
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D045283:Natriuretic Agents / Q000097:blood*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain