Yamamoto K, Burnett J C, Bermudez E A, Jougasaki M, Bailey K R, Redfield M M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Card Fail. 2000 Sep;6(3):194-200. doi: 10.1054/jcaf.2000.9676.
This study was designed to assess the use of clinical criteria and biochemical testing to detect systolic dysfunction. Our goal is to develop strategies that may enhance the detection and treatment of patients with early ventricular dysfunction while reducing the use of echocardiography.
We compared the predictive characteristics of the plasma brain natriuretic peptide (BNP) concentration with that of a 5-point clinical score derived from elements of the history, electrocardiogram, and chest radiograph in outpatients (n = 466) referred for echocardiography because of symptoms of heart failure or risk factors for systolic dysfunction. Systolic dysfunction was defined as an ejection fraction (EF) less than 45% and was present in 10.9% of patients. By receiver operating characteristic analysis, BNP was sensitive and specific for the detection of systolic dysfunction, with an area under the receiver operating characteristic curve for the detection of EF less than 45% of 0.79. The BNP assay was abnormal in 41% of patients and identified a group with a high prevalence of systolic dysfunction (21% with an EF less than 45%), whereas a normal BNP value identified a group with a low prevalence of systolic dysfunction (4% with an EF less than 45%). The clinical score was positive in 43% of the population and identified a group with a high prevalence of systolic dysfunction (24% with an EF less than 45%). A normal score identified a group with a low prevalence of systolic dysfunction (1% with an EF less than 45%).
This study supports previous studies, which showed that BNP assay predicts systolic dysfunction with acceptable sensitivity and specificity, and it underscores the effectiveness of additional readily available clinical criteria. Both of these strategies should be considered in screening for left ventricular dysfunction in populations at risk while limiting expensive cardiac imaging modalities.
本研究旨在评估临床标准和生化检测在检测收缩功能障碍中的应用。我们的目标是制定策略，以加强对早期心室功能障碍患者的检测和治疗，同时减少超声心动图的使用。
我们比较了血浆脑钠肽（BNP）浓度与基于病史、心电图和胸部X线检查得出的5分临床评分对因心力衰竭症状或收缩功能障碍风险因素而接受超声心动图检查的门诊患者（n = 466）的预测特征。收缩功能障碍定义为射血分数（EF）低于45%，10.9%的患者存在该情况。通过受试者工作特征分析可知，BNP对收缩功能障碍的检测具有敏感性和特异性，检测EF低于45%的受试者工作特征曲线下面积为0.79。41%的患者BNP检测异常，这些患者中收缩功能障碍的患病率较高（21%的患者EF低于45%），而BNP值正常的患者中收缩功能障碍的患病率较低（4%的患者EF低于45%）。43%的人群临床评分呈阳性，这些患者中收缩功能障碍的患病率较高（24%的患者EF低于45%）。评分正常的患者中收缩功能障碍的患病率较低（1%的患者EF低于45%）。
本研究支持先前的研究，这些研究表明BNP检测对收缩功能障碍的预测具有可接受的敏感性和特异性，并强调了其他易于获得的临床标准的有效性。在对有风险人群进行左心室功能障碍筛查时，应考虑这两种策略，同时限制使用昂贵的心脏成像检查手段。
