In patients with suspected SAP colour TDI performed at rest is an independent predictor of significant CAD, and colour TDI improves the diagnostic performance of exercise ECG.
Background: Echocardiography is the method of choice to detect left ventricular systolic dysfunction (LVSD), but access to this examination is limited. Therefore, simpler diagnostic tests would be of clinical importance. Objectives: We sought to evaluate the performance of a new N-terminal pro-brain natriuretic peptide (NT-proBNP) analysis in diagnosing LVSD in primary care patients with a provisional diagnosis of heart failure referred for echocardiography. Methods: Serum levels of NT-proBNP were measured with an immunoassay and left ventricular ejection fraction (LVEF) was assessed by echocardiography in 367 patients. Results: Mean age of the patients was 68.8 years (39.0–84.0 years), and 54% were female. Ten percent of the patients had LVEF <0.40. Depending on which cutoff values were used, NT-proBNP analysis detected patients with LVEF <0.40 with a sensitivity of 91–100% and specificity of 46–60%. If the limit for LVSD was set to 0.30, the sensitivity was 100% and the specificity ranged from 44 to 58%. The area under the receiver operating characteristics curves for detecting LVEF ≤0.30 and LVEF ≤0.40 was 0.93 and 0.87, respectively. Conclusion: Irrespective of which cut off value is used, normal NT-proBNP levels effectively rule out LVSD in primary care patients referred for echocardiographic evaluation of possible heart failure.
Vitamin D has been proposed as a risk factor of ischaemic heart disease. In 12 patients with acute myocardial infarction the major circulating vitamin D metabolite, 25-hydroxy-cholecalciferol (25-HCC), did not show any fluctuations during the first 4 days after onset of symptoms. The serum 25-HCC level was then measured in 128 patients consecutively admitted because of chest pain, 53 of whom had myocardial infarction and 75 had angina pectoris. The values found did not differ from those measured in 409 normal persons. The seasonal variations of serum 25-HCC were less pronounced in heart patients than in normals, probably due to less sun exposure in the summer months. The levels of serum 25-HCC did not correlate with the concentrations of serum cholesterol, glycerides, calcium or magnesium. Low serum calcium and magnesium were observed in all patients. Serum calcium was further reduced in the course of acute myocardial infarctions while serum parathyroid hormone rose significantly. We conclude that patients with ischaemic heart disease are not ingesting or producing in their skin elevated amount of vitamin D.
We identified prognostic threshold levels for mortality and CV hospitalization for NT-proBNP in primary care patients suspected of HF. Our results have the potential to be used to risk-stratify waiting lists for echocardiography.
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