Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000 Apr 1;320(7239):906-8.
doi: 10.1136/bmj.320.7239.906.

Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

H Smith  1 , R M Pickering, A Struthers, I Simpson, D Mant
Affiliations

Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

H Smith et al. BMJ. .

Abstract

Objective: To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people.

Design: Observational study.

Setting: General practice with four centres in Poole, Dorset.

Participants: 155 elderly patients aged 70 to 84 years.

Main outcome measures: Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography.

Results: The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%.

Conclusions: Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to "rule in" the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of plasma concentrations of B type natriuretic peptide in normal elderly people and in those with left ventricular systolic dysfunction confirmed by echocardiography
Figure 2
Figure 2
Receiver operator characteristic curve for plasma B type natriuretic peptide
See this image and copyright information in PMC

Comment in

References

    1. Morgan S, Smith H, Simpson I, Liddiard GS, Raphael H, Pickering RM, et al. The prevalence and clinical features of left ventricular dysfunction among a population of older adults. BMJ. 1999;318:368–372. - PMC - PubMed
    1. Remes J, Miettinen H, Reunanen A, Pyorala K. Validity of clinical diagnosis of heart failure in primary health care. Eur Heart J. 1991;12:315–321. - PubMed
    1. Sudoh T, Kangawa K, Minimamino N, Matsuo H. A new natriuretic peptide. Nature. 1988;322:78–81. - PubMed
    1. Struthers A. Ten years of natriuretic peptide research: a new dawn for their diagnostic and therapeutic use? BMJ. 1994;308:1615–1619. - PMC - PubMed
    1. Cowie MR, Struthers AD, Wood DA, Coats JS, Thompson SG, Poole-Wilson PA, et al. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet. 1997;350:1349–1353. - PubMed

Publication types