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Screening the population for left ventricular hypertrophy and left ventricular systolic dysfunction using natriuretic

James A de Lemos1, Darren K McGuire, Amit Khera

  • 1Donald W. Reynolds Cardiovascular Research Center, UT Southwestern Medical Center, Dallas, TX 75390-9047, USA. james.delemos@utsouthwestern.edu

American Heart Journal
|April 1, 2009
PubMed

Insights

Neither B-type natriuretic peptide (BNP) nor N-terminal pro-BNP (NT-proBNP) accurately identified left ventricular dysfunction in a general population. However, NT-proBNP showed slightly better screening performance in high-risk men.

Area of Science:

  • Cardiology
  • Biomarker Research
  • Diagnostic Imaging

Background:

  • Early identification of left ventricular systolic dysfunction (LVSD) and left ventricular hypertrophy (LVH) is crucial for timely treatment.
  • B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are investigated as potential screening biomarkers.

Purpose of the Study:

  • To evaluate the screening performance of BNP and NT-proBNP for LVSD and LVH.
  • To compare the diagnostic accuracy of BNP and NT-proBNP in diverse demographic and clinical subgroups.

Main Methods:

  • A cohort of 2,429 subjects from the Dallas Heart Study without prior heart conditions were assessed.
  • Cardiovascular magnetic resonance imaging (CMR) was used to define LVSD (ejection fraction <55%) and LVH.
  • Serum levels of BNP and NT-proBNP were measured and correlated with CMR findings.

Main Results:

  • Both BNP and NT-proBNP showed significant associations with LVH and LVSD (P < .0001).
  • Neither biomarker demonstrated high discriminatory power for LVH or LVSD in the overall cohort (AUROC <0.7).
  • In men aged 50+ or with hypertension, NT-proBNP exhibited superior performance (AUROC 0.73-0.79) compared to BNP (AUROC 0.63-0.69).

Conclusions:

  • BNP and NT-proBNP are not sufficiently accurate for general population screening of LVH or LVSD.
  • NT-proBNP offers a marginal improvement over BNP for screening high-risk men, comparable to other established screening tests.
Abstract

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