Prediction of ACC/AHA Stage B heart failure by clinical and neurohormonal profiling among patients in the community.
OBJECTIVE
N-Terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful test to "rule out" heart failure (HF) in patients presenting with dyspnea in primary care. However, many false positive diagnoses may occur. Early identification of abnormal left ventricular (LV) function would allow early intervention. The aim of this study was to predict LV dysfunction in these patients using a combination of neurohormones and other clinical factors.


RESULTS
A total of 190 people with dyspnea and/or peripheral edema were assessed. In those with NT-proBNP <100 pmol/L (n = 125), two models were constructed to predict LV dysfunction and so differentiate stage B HF from stage A and no HF. Model 1 included clinical factors and a range of neurohormones, whereas NT-proBNP was the only neurohormone in model 2. A model containing NT-proBNP, A-type NP, NT C-type NP, adrenomedullin, endothelin, creatinine, age, gender, body surface area, cardiothoracic ratio, and hypertension gave the lowest false negative rate (FNR) of 8.2%. The FNR of the model restricted to NT-proBNP as the only neurohormone was 13.7%.


CONCLUSIONS
This study demonstrated that by combining a neurohormonal profile with clinical variables, it is possible to differentiate stage B from stage A or no HF in patients presenting to primary care, enabling early intervention which can reduce the progression to stage C HF.
Department of Medicine, University of Auckland, New Zealand. k.poppe@auckland.ac.nz
Katrina K
KK
Poppe
Gillian A
GA
Whalley
A Mark
AM
Richards
Susan P
SP
Wright
Christopher M
CM
Triggs
Robert N
RN
Doughty
D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018377:Neurotransmitter Agents / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
D018377:Neurotransmitter Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain