Natriuretic peptides in the detection of preclinical diastolic or systolic dysfunction.
OBJECTIVE
The diagnostic value of natriuretic peptides in asymptomatic patients at risk for diastolic or systolic HF is controversial. We tested (1) the prevalence of preclinical LV dysfunction in an at-risk cohort; (2) the diagnostic accuracy of natriuretic peptides alone or in combination with clinical parameters for predicting asymptomatic left ventricular systolic or diastolic dysfunction.


METHODS
542 primary care patients (mean age 63 +/- 11 years, 42% female) without prediagnosed HF, but with risk factors for left ventricular dysfunction, underwent thorough cardiological workup, including echocardiography and analysis of natriuretic peptides.


RESULTS
23 patients (4%) showed reduced systolic function (EF < 50%), and 15 patients (3%) had severe diastolic dysfunction. All natriuretic peptides significantly increased with decreasing ejection fraction and with increasing degree of diastolic dysfunction. For natriuretic peptides, receiver operating characteristics analysis yielded good results for the detection of systolic dysfunction or severe diastolic dysfunction. Combining clinical parameters with natriuretic peptide data improved the diagnostic accuracy and largely reduced the number of needed screening echoes to identify patients with LV systolic or diastolic dysfunction.


CONCLUSIONS
The prevalence of preclinical diastolic dysfunction is high in primary care patients at risk, but the relative prevalence of severe diastolic dysfunction and systolic dysfunction is only 7%. High-risk individuals may be screened most efficiently by using a score system incorporating clinical data and NT-proBNP.
Luers
Claus
C
Department of Cardiology and Pneumology, University of Goettingen, Germany. cluers@gwdg.de
Wachter
Rolf
R
Kleta
Sibylle
S
Uhlir
Marc
M
Koschack
Janka
J
Scherer
Martin
M
Binder
Lutz
L
Herrmann-Lingen
Christoph
C
Zapf
Antonia
A
Kulle
Bettina
B
Kochen
Michael M
MM
Pieske
Burkert
B
D000368:Aged; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000209:etiology; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D066298:In Vitro Techniques; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000378:metabolism*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
D045265:Natriuretic Peptides