title: B-type Natriuretic Peptide (BNP) is useful in detecting asymptomatic left ventricular dysfunction in low-income, uninsured patients.
abstract: Low-income, uninsured individuals with multiple cardiovascular risk factors (CRFs) are at risk of heart failure (HF). B-type natriuretic peptide (BNP) screening for asymptomatic left ventricular dysfunction (ALVD) has not been tested specifically in this group. The purposes of this study were to describe BNP levels in asymptomatic low-income, uninsured individuals with multiple CRFs and determine the correlation between BNP levels and echocardiography for identifying ALVD.
  
  
  METHODS
  This correlational study included 53 patients (age 55 + or - 10 years, 83% non-White, 64% female). BNP testing and echocardiogram (ECHO) were performed.
  
  
  RESULTS
  Of the 30 patients (57%) diagnosed with ALVD by ECHO, 21 (40%) had diastolic and 9 (17%) systolic dysfunction. BNP levels were lower among those with normal left ventricular (LV) function (29.6 + or - 24 pg/mL) than those with diastolic (80.2 + or - 69 pg/mL, p = .01) and systolic dysfunction (337.1 + or - 374 pg/mL, p = .009). sParticipants with BNP > or = 50 pg/ mL were 5.75 times more likely to exhibit diastolic dysfunction (odds ratio [OR] = 5.75, 95% confidence interval [CI] 1.29- 25.51; p < .01) and those with BNP > or = 100 pg/mL were 7.80 times more likely to have systolic dysfunction (OR = 7.8, 95% CI 1.60-37.14; p < .005) than those with lower levels. With BNP cut point of 50 pg/mL, area under the curve (AUC) was 0.82 (95% CI 0.63-1.00) with sensitivity of 88% and specificity of 67%.
  
  
  CONCLUSIONS
  BNP is a low-cost method to detect ALVD in high-risk, uninsured, low-income individuals. Elevated BNP levels should prompt initiation of further diagnostic testing and early treatment.
authors.affiliation: University of California Los Angeles, School of Nursing, Acute Care Section, 700 Tiverton Ave., 4-242 Factor Building, Los Angeles, CA 90095, USA. aoconnel@sonnet.ucla.edu
authors.forename: Aurelia
authors.initials: A
authors.lastname: Macabasco-O'Connell
authors.forename: Sheba
authors.initials: S
authors.lastname: Meymandi
authors.forename: Robert
authors.initials: R
authors.lastname: Bryg
mesh_terms: D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011203:Poverty; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain