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[Type B natriuretic peptide in the diagnosis of heart failure with preserved systolic function]
1Serviço de Medicina 3, Serviço de Cardiologia, Hospital S. João, Porto.
Insights
B-type natriuretic peptide (BNP) shows high accuracy in diagnosing heart failure (HF) with preserved left ventricular systolic function (LVSF). BNP measurement can aid clinicians in identifying this common HF subtype, warranting further clinical practice studies.
Area of Science:
- Cardiology
- Diagnostic Medicine
- Biomarker Research
Context:
- Heart failure with preserved left ventricular systolic function (HFpEF) affects up to 50% of heart failure patients.
- A diagnostic consensus for HFpEF is currently lacking.
- Non-invasive diagnostic tools are crucial for managing HFpEF.
Purpose:
- To evaluate the diagnostic utility of B-type natriuretic peptide (BNP) for heart failure with preserved left ventricular systolic function (HFpEF).
Summary:
- A prospective study of 176 patients with suspected heart failure (HF) assessed B-type natriuretic peptide (BNP) levels.
- Patients with HF and preserved ejection fraction (>40%) showed significantly higher BNP levels compared to those without HF.
- Multivariate analysis identified BNP and systolic blood pressure as independent predictors of HFpEF, with BNP achieving an area under the curve of 0.94 for diagnosis.
Impact:
- BNP measurement demonstrates significant potential as a non-invasive biomarker for diagnosing HFpEF.
- These findings suggest BNP can assist clinicians in identifying patients with HFpEF.
- Further research is needed to establish BNP's role in routine clinical practice for HFpEF diagnosis.
Background:
Heart failure (HF) with preserved left ventricular systolic function (LVSF) is observed in up to 50% patients with HF. There is no consensus on non-invasive diagnosis of this entity.
Objective:
Evaluation of B-type natriuretic peptide (BNP) in the diagnosis of HF with preserved left ventricular systolic function.
Design:
Prospective study.
Patients:
One hundred and seventy-six consecutive patients with suspected HF were evaluated. Patients were classified as having HF with preserved LVSF, if they had symptoms and signs of HF, an ejection fraction greater than 40% and an abnormal Doppler pattern of the mitral inflow or atrial fibrilation and no other causes for the symptoms. All patients had a 12-lead EKG, chest roentgenogram, simple spirometry, M-mode and 2D echocardiogram with pulsed Doppler study of transmitral inflow and determination of plasma BNP levels.
Results:
Of the 176 patients, 65 had ejection fraction greater than 40%. Of these patients 46 were classified as having HF with preserved LVSF and 19 as not having HF. Patients with HF and preserved LVSF were older, had a higher systolic blood pressure (SBP), less pathologic Q waves on ECG and higher left ventricular ejection fraction and plasma BNP than patients without HF. Multivariate analysis revealed that BNP and SBP were independently associated with the diagnosis of HF. The accuracy of BNP in the diagnosis of HF with preserved LVSF evaluated by the area under the receiver operating characteristic curve was 0.94.
Conclusion:
These results suggest that the measurement of BNP levels can help clinicians in the diagnosis of HF with preserved LVSF. Whether BNP levels might be used in clinical practice as a test for the diagnosis of HF with preserved LVSF is a question that merits further studies.