Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care

BMJ 1998;317:516-519 ( 22 August )

General Practice

Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care

Samuel J McClure, clinical research fellow, ^a Lynn Caruana, cardiac technician, ^a Andrew P Davie, lecturer in cardiology, ^a Steven Goldthorp, general practitioner, ^b John J V McMurray, consultant cardiologist. ^a

^a Department of Cardiology, Western Infirmary, Glasgow G11 6NT, ^b Station Road Surgery, Milngavie, Glasgow

Correspondence to: Professor McMurray j.mcmurray{at}bio.gla.ac.uk

Objectives: To determine whether blood natriuretic peptide concentrations are helpful in identifying or excluding leftventricular systolic dysfunction in stable survivors of acutemyocardialinfarction.
Design: Comparison of blood natriuretic peptide concentrations with echocardiographic assessment of left ventricularsystolic function in a general practicepopulation.
Setting: Practices in Western District of Glasgow auditgroup.
Subjects: 134 long term survivors of myocardial infarction recalled for echocardiography as part of a primary caresecondary preventionaudit.
Main outcome measures: Area under the receiver operating curve for brain natriuretic peptide and N-terminal atrialnatriureticpeptide.
Results: Brain natriuretic peptide was of some diagnostic utility in identifying the minority of subjects with severeleft ventricular dysfunction (area under curve=0.73) but was unableto discriminate between patients with moderately severe dysfunctionand those with preserved left ventricular function (area undercurve for moderate or severe dysfunction=0.54). The correspondingvalues for N-terminal atrial natriuretic peptide for severe andmoderate or severe dysfunction were 0.55 and 0.56respectively.
Conclusions: Blood natriuretic peptide concentrations are not useful in identifying important left ventricular systolicdysfunction in stable survivors of myocardial infarction.

Key messages

Plasma concentrations of brain and N-terminal atrial natriuretic peptide increase in patients with left ventricular systolic dysfunction
Both peptides are stable in blood and can be measured relatively quickly and inexpensively.
In this general practice cohort of survivors of myocardial infarction brain natriuretic peptide had some value in identifying patients with severe left ventricular systolic dysfunction as determined by echocardiography
Measurement of either peptide concentration was unable to discriminate between patients with moderate left ventricular dysfunction and normal function
Brain and N-terminal atrial natriuretic peptide are not useful for detecting left ventricular systolic dysfunction in ordinary clinical practice

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