Risk assessment of left ventricular systolic dysfunction in primary care

doi:10.1136/bmj.321.7253.111/a

BMJ 2000;321:111 ( 8 July )

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Risk assessment of left ventricular systolic dysfunction in primary care

Drug treatment might be contaminating factor

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Drug treatment might be contaminating factor

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EDITOR $---$ The burden on echocardiography services could indeed be reduced if natriuretic peptide concentrations plus electrocardiographywere used as screening tools for left ventricular systolic dysfunction.¹Nielsen et al's paper confirms the high negative predictive valueof these tests. Concomitant drug treatment could, however, bea crucial contaminatingfactor.

The use of natriuretic peptides to diagnose left ventricular dysfunction in patients who are already taking cardiac drugsdeserves particular attention. Diuretics, digoxin, and angiotensinconverting enzyme inhibitors reduce natriuretic peptide concentrations.²Especially important is the fact that frusemide (furosemide) reducesthese concentrations³ but will have virtually no effect onan echocardiogram; it will not alter left ventricular dysfunction.Obviously, therefore, frusemide could severely distort the relationbetween natriuretic peptides and the echo finding of left ventricularsystolicdysfunction.

The predictive value of natriuretic peptides could conceivably be considerably affected by the presence of frusemide and othercardiac drugs. This . . . [Full text of this article]

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Risk assessment of left ventricular systolic dysfunction in primary care: cross sectional study evaluating a range of diagnostic tests: Olav Wendelboe Nielsen, Jørgen Fischer Hansen, Jørgen Hilden, Carsten Toftager Larsen, and Jens Svanegaard
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