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Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population
1Second Department of Medicine, Iwate Medical University, Morioka, Japan. nkmrmoto@iwate-med.ac.jp
Insights
Plasma B-type natriuretic peptide (BNP) measurement is an effective mass screening tool for detecting various cardiac abnormalities. This method efficiently identifies individuals at high risk for cardiovascular events, even without impaired left ventricular systolic function.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- Plasma B-type natriuretic peptide (BNP) utility for identifying impaired left ventricular (LV) systolic function in mass screening is debated.
- Cardiac abnormalities, irrespective of LV dysfunction severity, increase cardiovascular event risk.
Purpose of the Study:
- To evaluate plasma BNP measurement's validity for detecting diverse cardiac abnormalities.
- Focus on a population with low coronary heart disease and LV systolic dysfunction prevalence.
Main Methods:
- Cross-sectional study of 1098 subjects (mean age 56) in a Japanese health screening program.
- Plasma BNP levels measured via radioimmunoassay.
- Comprehensive health checkups including echocardiography.
Main Results:
- 39 subjects had various cardiac abnormalities; none had low LV ejection fraction (<40%).
- Receiver operating characteristic analysis identified an optimal BNP threshold of 50 pg/ml.
- High diagnostic accuracy: AUC 0.970, sensitivity 89.7%, specificity 95.7%.
Conclusions:
- Plasma BNP measurement is an efficient, cost-effective mass screening technique.
- Identifies patients with diverse cardiac abnormalities, irrespective of LV systolic dysfunction.
- Detects individuals at high risk for future heart failure and cardiovascular events.
Background:
Conflict exists regarding the usefulness of measuring plasma B type natriuretic peptide (BNP) concentrations for identifying impaired left ventricular (LV) systolic function during mass screening. Various cardiac abnormalities, regardless of degree of LV dysfunction, are prone to carry a high risk of cardiovascular events.
Objective:
To examine the validity of plasma BNP measurement for detection of various cardiac abnormalities in a population with a low prevalence of coronary heart disease and LV systolic dysfunction.
Design And Setting:
Participants in this cross sectional study attended a health screening programme in Iwate, northern Japan. Plasma BNP concentrations were determined in 1098 consecutive subjects (mean age 56 years) by direct radioimmunoassay. All subjects underwent multiphasic health checkups including physical examination, ECG, chest radiography, and transthoracic echocardiography.
Results:
Conventional diagnostic methods showed 39 subjects to have a wide range of cardiac abnormalities: lone atrial fibrillation or flutter in 11; previous myocardial infarction in seven; valvar heart disease in seven; hypertensive heart disease in six; cardiomyopathy in six; atrial septal defect in one; and cor pulmonale in one. No subjects had a low LV ejection fraction (< 40%). To assess the utility of plasma BNP measurement for identification of such patients, receiver operating characteristic analysis was performed. The optimal threshold for identification was a BNP concentration of 50 pg/ml with sensitivity of 89.7% and specificity of 95.7%. The area under the receiver operating characteristic curve was 0.970. The positive and negative predictive values at the cutoff level were 44.3% and 99.6%, respectively.
Conclusion:
Measurement of plasma BNP concentration is a very efficient and cost effective mass screening technique for identifying patients with various cardiac abnormalities regardless of aetiology and degree of LV systolic dysfunction that can potentially develop into obvious heart failure and carry a high risk of a cardiovascular event.
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