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The use of brain natriuretic peptide as a screening test for left ventricular systolic dysfunction-
Victor Sim1, David Hampton, Ceri Phillips
1Department of Medicine, Llandough Hospital, Vale of Glamorgan, UK. victor.sim@uhw-tr.wales.nhs.uk
Insights
Plasma brain natriuretic peptide (BNP) measurement can effectively pre-screen breathless patients for echocardiography. This approach offers significant cost savings without compromising diagnostic accuracy for left ventricular systolic dysfunction (LVSD).
Area of Science:
- Cardiology
- Diagnostic Medicine
- Biomarkers
Background:
- Left ventricular systolic dysfunction (LVSD) is prevalent but challenging to diagnose clinically.
- Early LVSD diagnosis is crucial for effective treatment and improved outcomes.
- Echocardiography is standard but costly and has limited availability.
Purpose of the Study:
- To evaluate the utility of plasma brain natriuretic peptide (BNP) as a selective pre-screening tool.
- To assess BNP's role in identifying patients needing open-access echocardiography.
- To determine if BNP can improve the efficiency of heart failure diagnosis.
Main Methods:
- Radioimmunoassay measurement of plasma BNP in 83 breathless patients.
- Standard echocardiography to assess left ventricular systolic function.
- Analysis of BNP levels against echocardiographic findings.
Main Results:
- Prevalence of LVSD was 31% in the study cohort.
- At a BNP threshold of 19 pg/ml, sensitivity was 100% and specificity 49.1% for LVSD.
- Using BNP as a pre-screen yielded net savings of £964.20 without diagnostic compromise.
Conclusions:
- BNP measurement is a cost-effective tool for selecting patients for echocardiography.
- BNP serves as a valuable pre-screening biomarker in primary care for suspected heart failure.
- This strategy enhances diagnostic efficiency and reduces healthcare costs.
Background:
Heart failure due to left ventricular systolic dysfunction (LVSD) has a high prevalence in the adult population but is difficult to diagnose accurately on clinical grounds in the community. Early diagnosis is important as effective treatments are available to reduce morbidity and mortality. Echocardiography is widely used to assess heart failure; however, this technology is relatively expensive and of limited availability. A potential diagnostic aid in primary care is the measurement of plasma brain natriuretic peptide (BNP).
Objective:
This study was performed to assess the value of BNP measurement as a selective pre-screen for breathless patients referred for open access echocardiography.
Methods:
BNP was measured by radioimmunoassay with prior extraction in 83 breathless subjects (age range 37-87 years, mean 72). Standard echocardiography was performed and left ventricular systolic function was assessed.
Results:
The prevalence of LVSD was 31% in this group. At cut-off values chosen to give negative predictive values for LVSD of >98% (BNP = 19 pg/ml), the sensitivity, specificity and positive predictive value for BNP were 100, 49.1 and 46.9%. Using this BNP threshold as a pre-screen for echocardiography would make a net saving of pound 964.20 without compromising the diagnostic accuracy.
Conclusion:
BNP measurement appears to have a significant cost-effective benefit for the selection of patients for echocardiography.
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