Comparison of Positive Cases for B-type Natriuretic Peptide and ECG Testing for Identification of Precursor Forms of Heart Failure in an Elderly Population

Abstract

SUMMARYPlasma B-type natriuretic peptide (BNP) levels have been reported to be elevated in various types of cardiac disorders and in precursors of CHF. To elucidate the potential ability of BNP testing to identify individuals with structural cardiac disease (ie, hypertensive heart disease, coronary heart disease, valvular heart disease) among communitydwelling elderly persons, cases which were positive on BNP testing were compared to those positive on ECG testing.In the initial phase, we performed plasma BNP measurements and ECG in 856 participants (age ≥ 65 years) selected from a general population. From within this group, subjects with an abnormal ECG (n = 125) were selected according to the Minnesota code. Subjects with elevated BNP were selected independently on the basis of plasma levels (n = 112). In the next phase, subjects in both groups were invited to complete Rose's angina questionnaire and to undergo physical examination and transthoracic echocardiography. In this subject group (positive in ECG testing and/or BNP testing), the two tests had comparable sensitivity (65% versus 59%: NS) and specificity (40% versus 41%: NS) for identifying hypertensive heart disease (n = 17). For coronary heart disease (n = 12), the two tests had also comparable sensitivity (58% versus 42%: NS) and specificity (39% versus 41%: NS). However, for selection of valvular heart disease (n = 7), BNP testing had higher sensitivity than ECG testing (100% versus 14%; P < 0.01) with comparable specificity (43% versus 40%: NS).Several types of structural heart disease, in particular valvular heart disease, could be identified exclusively by BNP testing, suggesting that BNP measurement can make a significant contribution to screening for CHF precursors when used in combination with ECG in elderly populations. (Int Heart J 2005; 46: 477-487)

Cardiovascular risk factors in the Japanese northeastern rural population

“…Plasma BNP assays were performed for 65.6% of the subjects in the study. The method for measuring plasma BNP levels was previously described in detail [8].…”

“…Both mean hsCRP level in all subjects and that in subjects after excluding subjects with hsCRP levels greater than 10 mg/L are shown in this study. We defined high BNP level as 50 pg/mL or more according to our previous study [8]. Macroalbuminuria was defined as UACR being 300 mg/g or more, and microalbuminuria was defined as UACR being 30 mg/g or more and less than 300 mg/g.…”

Natriuretic peptide testing in primary care patients

“…Furthermore, the prognostic role of the BNP/NT-proBNP assay was well demonstrated in primary care HF patients (17,71). Finally, compared to standard echocardiography, the BNP/ NT-proBNP assay shows lower cost and similar diagnostic accuracy (87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101), and peptide measurement may be preferred, due to its better efficiency, in screening of high-risk populations, such as elderly patients (99)(100)(101), or for assessment of diastolic dysfunction (2,104,105). Collaboration between generalists and cardiologists, rather than solo care by either, which is associated with better HF processes and outcomes of care (106), would benefit from the correct application of natriuretic peptide testing in primary care.…”

The relationship between long-term changes in plasma B-type natriuretic peptide levels and electrocardiographic findings

“…Recent studies have revealed relationships between BNP and age, BNP and lipids, and BNP and gender as well as the usefulness of BNP in predicting the risk and severity of ischemic heart disease and arrhythmia [8][9][10][11][12]. A few studies have also shown the sensitivity and specificity of BNP in predicting the risk of heart disease in comparison to electrocardiographic (ECG) and echocardiographic findings, but as these have all been one-time measurements of BNP, the significance of the findings is still under debate [13][14][15][16][17][18][19]. Long-term changes in BNP with respect to metabolic syndrome factors have also been investigated [20], but a relationship to changes in ECG findings has not yet been reported.…”