BMJ 2000;320:906-908 ( 1 April )

General Practice

Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

H Smith, senior lecturer, a R M Pickering, lecturer, b A Struthers, professor, c I Simpson, consultant cardiologist, d D Mant, professor. e

a Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, b Medical Statistics and Computing, University of Southampton, Southampton General Hospital SO16 6YD, c Department of Clinical Pharmacology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, d Department of Cardiology, Wessex Cardiothoracic Centre, Southampton General Hospital, e Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF

Correspondence to: H Smith hes{at}soton.ac.uk

Objective: To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people.
Design: Observational study.
Setting: General practice with four centres in Poole, Dorset.
Participants: 155 elderly patients aged 70 to 84 years.
Main outcome measures: Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography.
Results: The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%.
Conclusions: Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to "rule in" the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.


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Rapid Responses:

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Biochemical diagnosis of ventricular dysfunction in elderly patients is not fully justified
Wai-Ching Leung
bmj.com, 2 Apr 2000 [Full text]
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