Cohort study of plasma natriuretic peptides for identifying left ventricular systolic dysfunction in primary care.

OBJECTIVES

To determine whether blood natriuretic peptide concentrations are helpful in identifying or excluding left ventricular systolic dysfunction in stable survivors of acute myocardial infarction.

DESIGN

Comparison of blood natriuretic peptide concentrations with echocardiographic assessment of left ventricular systolic function in a general practice population.

SETTING

Practices in Western District of Glasgow audit group.

SUBJECTS

134 long term survivors of myocardial infarction recalled for echocardiography as part of a primary care secondary prevention audit.

MAIN OUTCOME MEASURES

Area under the receiver operating curve for brain natriuretic peptide and N-terminal atrial natriuretic peptide.

RESULTS

Brain natriuretic peptide was of some diagnostic utility in identifying the minority of subjects with severe left ventricular dysfunction (area under curve=0.73) but was unable to discriminate between patients with moderately severe dysfunction and those with preserved left ventricular function (area under curve for moderate or severe dysfunction=0.54). The corresponding values for N-terminal atrial natriuretic peptide for severe and moderate or severe dysfunction were 0.55 and 0.56 respectively.

CONCLUSIONS

Blood natriuretic peptide concentrations are not useful in identifying important left ventricular systolic dysfunction in stable survivors of myocardial infarction.