title: [Screening of asymptomatic left ventricular systolic dysfunction in a population sample at high cardiovascular risk in Lombardy (Italy): the DAVID-Berg study].
abstract: BACKGROUND
  Prevalence of asymptomatic left ventricular systolic dysfunction (ALVSD) increases with age and cardiovascular (CV) risk exposure. Early diagnosis and treatment allow reducing heart failure and fatal and non-fatal event rates. Data on ALVSD prevalence in Italy are still scarce and ALVSD remains commonly under-diagnosed in primary care, where diagnostic facilities are limited. Among subjects at high CV risk in primary care, we assessed the prevalence of ALVSD and the relative predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the Framingham Heart Failure Risk Score (FHFRS).
  
  
  METHODS
  Records of 4047 subjects aged 55-80 years, without history, symptoms or signs of heart failure, registered at three primary care practices in Lombardy, Northern Italy, were reviewed; 623 subjects at high CV risk underwent visit, ECG, echocardiography, NT-proBNP and FHFRS calculation.
  
  
  RESULTS
  ALVSD, defined as left ventricular ejection fraction <50%, was detected in 33 subjects (5.3%) who showed higher NT-proBNP (p<0.001) and FHFRS (p=0.013) than those without ALVSD. NT-proBNP levels beyond normal age and gender-specific 95th percentile had a 97.7% negative predictive value for ALVSD and were associated with a 6-fold increase in ALVSD risk. Adding NT-proBNP to FHFRS significantly improved prediction (C-statistic 0.76, 95% confidence interval [CI] 0.67-0.84 vs 0.63, 95% CI 0.53-0.73, p=0.04; net reclassification improvement 38.4%). The combination of FHFRS and major ECG abnormalities was not superior to stand alone NT-proBNP (C-statistic 0.71, 95% CI 0.63-0.80 vs 0.74, 95% CI 0.64-0.83, p=0.61).
  
  
  CONCLUSIONS
  In subjects at high CV risk in primary care, prevalence of ALVSD is 5.3%; for diagnosis NT-proBNP adds predictive value to the FHFRS and is equivalent to the combination of FHFRS and ECG. Because of its practical advantages, NT-proBNP might be routinely used for ALVSD screening in primary care.
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.forename: Aurelia
authors.initials: A
authors.lastname: Grosu
authors.forename: Attilio
authors.initials: A
authors.lastname: Iacovoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fontana
authors.forename: Mauro
authors.initials: M
authors.lastname: Gori
authors.forename: Paola
authors.initials: P
authors.lastname: Ferrari
authors.forename: Paolo
authors.initials: P
authors.lastname: Canova
authors.forename: Alice
authors.initials: A
authors.lastname: Calabrese
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rutili
authors.forename: Luigi
authors.initials: L
authors.lastname: Donzelli
authors.forename: Marina
authors.initials: M
authors.lastname: Parolini
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008499:Medical Records; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010045:Outpatients / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain