title: Clinical applicability of B-type natriuretic peptide in patients with suspected heart failure in primary care in Spain: the PANAMA study.
abstract: OBJECTIVE
  To assess the predictive value of B-type natriuretic peptide (BNP) in the diagnosis of heart failure (HF) in a primary-care setting in Spain.
  
  
  METHODS
  PANAMA was a multicenter and cross-sectional study. Patients ≥18 years of age with a clinical diagnosis of HF (Framingham criteria) were consecutively included in the study by primary-care investigators. BNP determination and an echocardiogram were performed in every patient. The cut-off point of BNP for the criterion of exclusion of HF was considered as <100 pg/ml, as suggested by European guidelines. Sensitivity, specificity, positive-predictive value and negative-predictive value were calculated.
  
  
  RESULTS
  A total of 72 patients (mean age: 75.1 ± 8.7 years; 74.6% women) were included. The most frequent associated risk factors were hypertension (75.6%) and dyslipidemia (54.3%). The most common major and minor criteria of HF according to Framingham criteria were radiographic cardiomegaly (90.2%) and dyspnea on ordinary exertion (100%), respectively. BNP median was 49 pg/ml (33.3 pg/ml in those with a doubtful diagnosis of HF and 83.3 pg/ml in those with a likely diagnosis of HF). Approximately 60% of patients exhibited diastolic dysfunction. Concerning accuracy parameters comparing BNP >100 pg/ml with echocardiogram, sensitivity was 25%, the specificity 80.8%, and the positive- and negative-predictive values were 68.8 and 38.9%, respectively.
  
  
  CONCLUSIONS
  In patients attended by general practitioners, BNP >100 pg/ml may be a useful diagnostic tool with a high specificity for the diagnosis of HF.
authors: Department of Cardiology, Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain. vbarriosa@meditex.es
authors: Vivencio
authors: V
authors: Barrios
authors: José Luis
authors: JL
authors: Llisterri
authors: Carlos
authors: C
authors: Escobar
authors: Pilar
authors: P
authors: Alfaro
authors: Francisco
authors: F
authors: Colado
authors: Francisco
authors: F
authors: Ridocci
authors: Arantxa
authors: A
authors: Matali