No abstract

Amino-terminal pro-BNP in normal patients is affected primarily by gender and age, which should be considered when interpreting values. Importantly, in the entire population sample NT-proBNP performed at least equivalently to BNP in detecting LV dysfunction and was superior in some subgroups in detecting LV systolic dysfunction.

Application of existing SPECT MPI appropriateness criteria is demanding and requires an established database or detailed data collection, as well as a number of assumptions. Fourteen percent of stress SPECT studies and 18% of stress echo studies were performed for inappropriate reasons. Quality improvement efforts directed at reducing the number of these inappropriate studies may improve efficiency in the health care system.

No abstract

Abstract-Recent studies report that, in the absence of heart failure and renal failure, plasma B-type natriuretic peptide (BNP) has prognostic value for mortality. We sought to confirm and extend these previous studies to assess BNP, measured by 3 distinct assays, as a biomarker for mortality in a strategy to enhance efforts at primary prevention and to better understand the clinical phenotype of such subjects at risk. We used a community-based cohort of 2042 subjects from Olmsted County, Minn, and individuals with heart or renal failure were excluded. BNP was assessed using 3 assays including Biosite and Shionogi for mature, biologically active BNP and the Roche assay for apparently nonbiologically active amino-terminal pro-BNP (NT-proBNP). Thorough echocardiographic and clinical data were recorded for all of the participants. Median follow-up for mortality was 5.6 years. BNP by all 3 of the assays was predictive of mortality. NT-proBNP and Biosite assays remained significant even after adjustment for traditional clinical risk factors and echocardiographic abnormalities including left ventricular hypertrophy and diastolic dysfunction. Echocardiography documented widespread structural changes in those with increasing BNP levels yet below levels observed in heart failure. We report in a large, well-characterized community-based cohort, free of heart failure, the first study to compare 3 distinct BNP assays as biomarkers for mortality in the same cohort. Our findings confirm the potential use of NT-proBNP and BNP biomarkers for future events and underscore that these peptides may also serve as biomarkers for underlying cardiac remodeling secondary to diverse cardiovascular disease entities. Key Words: natriuretic peptide Ⅲ hypertrophy T he cardiac hormone B-type natriuretic peptide (BNP) has proved useful in the diagnosis of human heart failure (HF). 1-3 Recently, studies have provided compelling data that plasma BNP, even in the absence of HF, has prognostic value for future cardiovascular events. 4 -6 Specifically, Wang et al 4 from the Framingham Heart Study reported in a prospective investigation in the general population without HF or renal failure that with each 1 SD increase in log BNP levels, there were significant increases in the risk of death, HF, atrial fibrillation, stroke or TIA, and first cardiovascular event over 5.2 mean years of follow-up. The reported plasma values associated with increased risk were well below the HF diagnosis threshold of 100 pg/mL. These important results suggest that, in the absence of HF, before the development of overt cardiac disease, modest elevations in plasma BNP are meaningful. Whereas this previous study provided significant information regarding the prognostic implications of BNP values below those seen in HF, the Framingham Heart Study 4 and others 5,7 have asked for validation of these findings in additional large, community-based studies.The current study was, therefore, designed to validate, as well as extend these recent seminal reports. We used the Prevalence ...