HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Ng, L. L. Articles by Squire, I. B. Search for Related Content PubMed PubMed Citation Articles by Ng, L. L. Articles by Squire, I. B.

CLINICAL RESEARCH: HEART FAILURE

Community screening for left ventricular systolic dysfunction using plasma and urinary natriuretic peptides

Leong L. Ng, MD^_*,_*, Ian W. Loke, MB^_*, Joan E. Davies, PhD^_*,, Sandeep Geeranavar, BSc^_*, Kamlesh Khunti, MD, Margaret A. Stone, PhD, Derek T. Chin, MB and Iain B. Squire, MD^_*

^_* Department of Cardiovascular Sciences, University of Leicester, United Kingdom
Department of Health Sciences, University of Leicester, United Kingdom
Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom

Manuscript received May 17, 2004; accepted December 10, 2004.

^_* Reprint requests and correspondence: Prof. Leong L. Ng, Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, United Kingdom (Email: lln1{at}le.ac.uk).

OBJECTIVES: We sought to compare urinary and plasma N-terminal pro-brain natriuretic peptide (N-BNP) in left ventricular systolic dysfunction (LVSD) diagnosis.

BACKGROUND: Plasma N-BNP is elevated in LVSD. Renal tubule cells produce BNP. We tested the incremental value of urinary N-BNP in LVSD diagnosis.

METHODS: In this prospective, community-screening study of undiagnosed LVSD, 1,360 subjects (45 to 80 years of age) were invited, and 1,308 had analyzable echocardiographic scans and urine and plasma specimens. The criterion standard for LVSD was defined as a wall motion score over 1.8 (ejection fraction 40%).

RESULTS: Twenty-eight patients with LVSD had elevated urinary and plasma N-BNP levels compared with normal subjects (p < 0.0005). Receiver-operating characteristic (ROC) areas under the curve (AUCs) for urinary and plasma N-BNP were 0.831 and 0.840, respectively. Both tests had high negative predictive values (>99%) for excluding LVSD. Urinary N-BNP was more specific (67.2%) than plasma N-BNP (41%). The plasma/urinary N-BNP product yielded a higher ROC-AUC (0.923) and specificity (78%), reducing the number of cases to scan to detect one case of LVSD to 11.4 (compared with 16.6 [urinary N-BNP] and 29.0 [plasma N-BNP]). Sequential application of tests (urinary N-BNP, then plasma N-BNP in the urine-"positive" cases) achieved similar reductions in the number of cases to scan (10.8), while limiting the number of N-BNP tests to be performed. Urinary N-BNP performed poorly in detection of other cardiac abnormalities with preserved systolic function. It was less costly to test urinary N-BNP in the whole population as compared with other strategies, including scanning high-risk cases with N-BNP testing in the remainder.

CONCLUSIONS: Urinary N-BNP used together with plasma N-BNP could reduce the echocardiographic burden in screening programs.

Abbreviations and Acronyms   AF = atrial fibrillation   AUC = area under the curve   IHD = ischemic heart disease   LVSD = left ventricular systolic dysfunction   LVWMI = left ventricular wall motion index   N-BNP = N-terminal pro-brain natriuretic peptide   NPV = negative predictive value   PPV = positive predictive value   ROC = receiver-operating characteristic

This article has been cited by other articles:

				E. C H J Michielsen, J. A Bakker, R. R J V. Kimmenade, Y. M Pinto, and M. P V. Dieijen-Visser The diagnostic value of serum and urinary NT-proBNP for heart failure Ann Clin Biochem, July 1, 2008; 45(4): 389 - 394. [Abstract] [Full Text] [PDF]

				A M. Richards Variability of NT-proBNP levels in heart failure: implications for clinical application Heart, August 1, 2007; 93(8): 899 - 900. [Abstract] [Full Text] [PDF]

				R. Cortes, M. Rivera, A. Salvador, V. Bertomeu, F. G. de Burgos, E. Rosello-Lleti, M. Portoles, R. Paya, L. Martinez-Dolz, and V. Climent Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study Heart, August 1, 2007; 93(8): 957 - 962. [Abstract] [Full Text] [PDF]

				J. P. Goetze, R. Mogelvang, L. Maage, H. Scharling, P. Schnohr, P. Sogaard, J. F. Rehfeld, and J. S. Jensen Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction Eur. Heart J., December 2, 2006; 27(24): 3004 - 3010. [Abstract] [Full Text] [PDF]

				R. S. Vasan Biomarkers of Cardiovascular Disease: Molecular Basis and Practical Considerations Circulation, May 16, 2006; 113(19): 2335 - 2362. [Full Text] [PDF]

				M. Schou, M. K. Dalsgaard, O. Clemmesen, E. A. Dawson, C. C. Yoshiga, H. B. Nielsen, F. Gustafsson, P. R. Hildebrandt, and N. H. Secher Kidneys extract BNP and NT-proBNP in healthy young men J Appl Physiol, November 1, 2005; 99(5): 1676 - 1680. [Abstract] [Full Text] [PDF]