TY - JOUR
T1 - Screening the population for left ventricular hypertrophy and left ventricular systolic dysfunction using natriuretic peptides
T2 - Results from the Dallas Heart Study
AU - de Lemos, James A
AU - McGuire, Darren K
AU - Khera, Amit
AU - Das, Sandeep R
AU - Murphy, Sabina A.
AU - Omland, Torbjorn
AU - Drazner, Mark H
N1 - Funding Information:
The Dallas Heart Study was funded by the Donald W. Reynolds Foundation (Las Vegas, NE). Additional funding and reagents for the present studies were provided by Biosite Inc and Roche Diagnostics. The authors are solely responsible for the study design, analyses, and all drafts of the article.
Funding Information:
Dr de Lemos has received grant support from Biosite, San Diego, CA, and consulting fees from Biosite/Inverness and Roche Diagnostics, Indianapolis, IN. Dr McGuire has received grant support from Biosite/Inverness.
PY - 2009/4
Y1 - 2009/4
N2 - Background: Identification of individuals in the community with left ventricular systolic dysfunction (LVSD) or left ventricular hypertrophy (LVH) may allow earlier initiation of disease-modifying treatment. We performed a comprehensive evaluation of the screening performance of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for LVSD or LVH. Methods: In 2,429 subjects without a history of heart failure, myocardial infarction, valvular abnormalities, or a serum creatinine >2.0 mg/dL enrolled in the Dallas Heart Study, measurement of BNP and NT-proBNP and cardiovascular magnetic resonance imaging were performed. Results: B-type natriuretic peptide and NT-proBNP were robustly associated with magnetic resonance imaging-defined LVH and LVSD (ejection fraction <55%) among men and women (P < .0001 for each). In the overall population, neither test discriminated well for LVH or LVSD (area under the receiver operating characteristic curve [AUROC] <0.7). Among women, no differences in AUROC were observed between BNP and NT-proBNP. Among men, AUROCs were similar between BNP and NT-proBNP in the overall population, but among subgroups age 50 or older, or with hypertension, the AUROCs for NT-proBNP (0.73-0.79) were higher than for BNP (0.63-0.69, P < .05 for each comparison). Compared with subjects with isolated BNP elevation (>97.5th percentile), those with isolated NT-proBNP elevation had worse renal function and more LVH and coronary calcium (P < .05 for each). Conclusions: Overall, neither BNP nor NT-proBNP accurately discriminated subjects with LVH or LVSD in this predominately young and healthy population-based cohort. However, among high-risk men, NT-proBNP performed slightly better than BNP and comparably with other routinely used screening tests such as prostate-specific antigen measurement for prostate cancer.
AB - Background: Identification of individuals in the community with left ventricular systolic dysfunction (LVSD) or left ventricular hypertrophy (LVH) may allow earlier initiation of disease-modifying treatment. We performed a comprehensive evaluation of the screening performance of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for LVSD or LVH. Methods: In 2,429 subjects without a history of heart failure, myocardial infarction, valvular abnormalities, or a serum creatinine >2.0 mg/dL enrolled in the Dallas Heart Study, measurement of BNP and NT-proBNP and cardiovascular magnetic resonance imaging were performed. Results: B-type natriuretic peptide and NT-proBNP were robustly associated with magnetic resonance imaging-defined LVH and LVSD (ejection fraction <55%) among men and women (P < .0001 for each). In the overall population, neither test discriminated well for LVH or LVSD (area under the receiver operating characteristic curve [AUROC] <0.7). Among women, no differences in AUROC were observed between BNP and NT-proBNP. Among men, AUROCs were similar between BNP and NT-proBNP in the overall population, but among subgroups age 50 or older, or with hypertension, the AUROCs for NT-proBNP (0.73-0.79) were higher than for BNP (0.63-0.69, P < .05 for each comparison). Compared with subjects with isolated BNP elevation (>97.5th percentile), those with isolated NT-proBNP elevation had worse renal function and more LVH and coronary calcium (P < .05 for each). Conclusions: Overall, neither BNP nor NT-proBNP accurately discriminated subjects with LVH or LVSD in this predominately young and healthy population-based cohort. However, among high-risk men, NT-proBNP performed slightly better than BNP and comparably with other routinely used screening tests such as prostate-specific antigen measurement for prostate cancer.
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U2 - 10.1016/j.ahj.2008.12.017
DO - 10.1016/j.ahj.2008.12.017
M3 - Article
C2 - 19332205
AN - SCOPUS:62949168054
SN - 0002-8703
VL - 157
SP - 746-753.e2
JO - American heart journal
JF - American heart journal
IS - 4
ER -