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General Practice

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

BMJ 1998; 317 doi: (Published 22 August 1998) Cite this as: BMJ 1998;317:516
  1. Samuel J McClure, clinical research fellowa,
  2. Lynn Caruana, cardiac techniciana,
  3. Andrew P Davie, lecturer in cardiologya,
  4. Steven Goldthorp, general practitionerb,
  5. John J V McMurray (j.mcmurray{at}, consultant cardiologist.a
  1. a Department of Cardiology, Western Infirmary, Glasgow G11 6NT
  2. bStation Road Surgery, Milngavie, Glasgow
  1. Correspondence to: Professor McMurray
  • Accepted 22 August 1998


Objectives : To determine whether blood natriuretic peptide concentrations are helpful in identifying or excluding left ventricular systolic dysfunction in stable survivors of acute myocardial infarction.

Design : Comparison of blood natriuretic peptide concentrations with echocardiographic assessment of left ventricular systolic function in a general practice population.

Setting : Practices in Western District of Glasgow audit group.

Subjects : 134 long term survivors of myocardial infarction recalled for echocardiography as part of a primary care secondary prevention audit.

Main outcome measures : Area under the receiver operating curve for brain natriuretic peptide and N-terminal atrial natriuretic peptide.

Results : Brain natriuretic peptide was of some diagnostic utility in identifying the minority of subjects with severe left ventricular dysfunction (area under curve=0.73) but was unable to discriminate between patients with moderately severe dysfunction and those with preserved left ventricular function (area under curve for moderate or severe dysfunction=0.54). The corresponding values forN-terminal atrial natriuretic peptide for severe and moderate or severe dysfunction were 0.55 and 0.56 respectively.

Conclusions : Blood natriuretic peptide concentrations are not useful in identifying important left ventricular systolic dysfunction in stable survivors of myocardial infarction.


  • Funding None.

  • Conflict of interest None.

  • Accepted 22 August 1998
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