Corteville David C M, Bibbins-Domingo Kirsten, Wu Alan H B, Ali Sadia, Schiller Nelson B, Whooley Mary A
Department of Medicine, University of California, San Francisco, CA, USA.
Arch Intern Med. 2007 Mar 12;167(5):483-9. doi: 10.1001/archinte.167.5.483.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing is useful for diagnosing acute decompensated heart failure. Whether NT-proBNP can be used to detect ventricular dysfunction in patients with stable coronary heart disease (CHD) and no history of heart failure is unknown.
We measured NT-proBNP levels and performed transthoracic echocardiography in 815 participants from the Heart and Soul Study, who had stable CHD and no history of heart failure. We hypothesized that NT-proBNP concentrations lower than 100 pg/mL would rule out ventricular dysfunction and concentrations higher than 500 pg/mL would identify ventricular dysfunction. We calculated sensitivities, specificities, likelihood ratios, and areas under the receiver operating characteristic curves for NT-proBNP as a case-finding instrument for systolic and diastolic dysfunction.
Of the 815 participants with no history of heart failure, 68 (8%) had systolic dysfunction defined as a left ventricular ejection fraction of 50% or lower. Of the 730 participants for whom the presence or absence of diastolic dysfunction could be determined, 78 (11%) had diastolic dysfunction defined as a pseudonormal or restrictive filling pattern. The overall area under the receiver operating characteristic curve for detecting systolic or diastolic dysfunction was 0.78 (95% confidence interval, 0.74-0.82). Likelihood ratios were 0.28 for NT-proBNP concentrations lower than 100 pg/mL, 0.95 for concentrations between 100 and 500 pg/mL, and 4.1 for concentrations higher than 500 pg/mL. A test result lower than 100 pg/mL reduced the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 6%. A test result higher than 500 pg/mL increased the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 47%. A test result between 100 and 500 pg/mL did not change the probability of ventricular dysfunction.
In patients with stable CHD and no history of heart failure, NT-proBNP levels lower than 100 pg/mL effectively rule out ventricular dysfunction, with a negative likelihood ratio of 0.28.
N末端B型利钠肽原（NT-proBNP）检测对于诊断急性失代偿性心力衰竭很有用。NT-proBNP是否可用于检测稳定型冠心病（CHD）且无心力衰竭病史患者的心室功能障碍尚不清楚。
我们对来自“心灵研究”的815名患有稳定型CHD且无心力衰竭病史的参与者测量了NT-proBNP水平并进行了经胸超声心动图检查。我们假设NT-proBNP浓度低于100 pg/mL可排除心室功能障碍，而浓度高于500 pg/mL可识别心室功能障碍。我们计算了NT-proBNP作为收缩和舒张功能障碍病例发现工具的敏感性、特异性、似然比以及受试者工作特征曲线下面积。
在815名无心力衰竭病史的参与者中，68名（8%）有收缩功能障碍，定义为左心室射血分数为50%或更低。在730名可确定有无舒张功能障碍的参与者中，78名（11%）有舒张功能障碍，定义为伪正常或限制性充盈模式。检测收缩或舒张功能障碍的受试者工作特征曲线下总面积为0.78（95%置信区间，0.74 - 0.82）。NT-proBNP浓度低于100 pg/mL时似然比为0.28，浓度在100至500 pg/mL之间时为0.95，浓度高于500 pg/mL时为4.1。检测结果低于100 pg/mL将心室功能障碍的概率从检测前概率18%降低至检测后概率6%。检测结果高于500 pg/mL将心室功能障碍的概率从检测前概率18%提高至检测后概率47%。检测结果在100至500 pg/mL之间未改变心室功能障碍的概率。
在稳定型CHD且无心力衰竭病史的患者中，NT-proBNP水平低于100 pg/mL可有效排除心室功能障碍，阴性似然比为0.28。
