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Community screening for left ventricular systolic dysfunction using plasma and urinary natriuretic peptides
Leong L Ng1, Ian W Loke, Joan E Davies
1Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, United Kingdom. lln1@le.ac.uk
Journal of the American College of Cardiology
|April 6, 2005
Summary
Urinary N-terminal pro-brain natriuretic peptide (N-BNP) combined with plasma N-BNP can improve left ventricular systolic dysfunction (LVSD) diagnosis. This approach reduces the need for echocardiograms in screening programs.
Area of Science:
- Cardiology
- Biomarker Research
- Diagnostic Imaging
Background:
- Plasma N-BNP is a known indicator of left ventricular systolic dysfunction (LVSD).
- Renal tubule cells are a source of BNP production.
- The study investigates the added diagnostic value of urinary N-BNP for LVSD.
Purpose of the Study:
- To compare the diagnostic utility of urinary N-BNP versus plasma N-BNP for LVSD.
- To evaluate the combined use of urinary and plasma N-BNP in diagnosing LVSD.
- To assess the impact of these biomarkers on reducing echocardiographic screening burden.
Main Methods:
- A prospective community-screening study involving 1,308 participants aged 45-80.
- Echocardiography was used as the criterion standard for LVSD diagnosis (wall motion score > 1.8).
- Urinary and plasma N-BNP levels were analyzed in all participants.
Main Results:
- Both urinary and plasma N-BNP were significantly elevated in patients with LVSD (p < 0.0005).
- The plasma/urinary N-BNP product demonstrated superior diagnostic performance (ROC-AUC 0.923) and specificity (78%) compared to individual tests.
- Combined testing reduced the number of echocardiograms needed to detect one LVSD case to 11.4, with sequential testing achieving similar efficiency.
Conclusions:
- The combination of urinary and plasma N-BNP offers a more specific and efficient method for LVSD screening.
- This biomarker-based strategy can significantly decrease the reliance on echocardiography in population screening.
- Urinary N-BNP, particularly in conjunction with plasma N-BNP, presents a cost-effective approach to cardiac screening.