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Utility of N terminal pro brain natriuretic peptide in elderly patients
  1. R Sivakumar1,
  2. D Wellsted2,
  3. K Parker1,
  4. M Lynch1,
  5. P Ghosh1,
  6. S A Khan1
  1. 1Lister Hospital, Stevenage, UK
  2. 2HRDSU, University of Hertfordshire, UK
  1. Correspondence to:
 Dr S A Khan
 Strathmore Wing, Lister Hospital, Stevenage SG1 4AB, UK; shahidAK{at}aol.com

Abstract

Objective: To evaluate the utility of N terminal pro brain natriuretic peptide (NT-proBNP) as a diagnostic marker for diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders in patients over 75 years.

Design: Cohort study.

Setting: Outpatient echocardiography service in a district general hospital.

Participants: 100 consecutive patients.

Main outcome measures: Sensitivity, specificity, positive predictive values, negative predictive values, and area under receiver operating characteristic curve for NT-proBNP assay in the diagnosis of left ventricular diastolic dysfunction or failure, systolic dysfunction, and significant valve disorders.

Results: For diagnosis of systolic dysfunction NT-proBNP level of 424 pg/ml had a sensitivity of 96%, specificity of 45%, positive predictive value of 36%, and negative predictive value of 96%. The area under the curve was 0.71 (95% confidence intervals: 0.69 to 0.89). In valve heart disease, level of 227 pg/ml had sensitivity of 91%, specificity of 43%, positive predictive value of 40%, and negative predictive value of 92%. Patients with diastolic dysfunction/failure had lower plasma concentrations.

Conclusions: This study showed that NT-proBNP had excellent negative predictive value for systolic dysfunction and significant valve disorders in very elderly patients. It increased significantly in systolic dysfunction, valve heart disease, and atrial fibrillation. NT-proBNP is not useful in the diagnosis of diastolic dysfunction or diastolic heart failure using standard echocardiography criteria.

  • NT-proBNP, N terminal pro brain natriuretic peptide
  • AUC, area under curve
  • LV, left ventricular
  • LA, left atrial
  • DT, deceleration time
  • IVRT, isovolumetric relaxation time
  • ROC, receiver operating characteristic curve
  • heart failure
  • diastolic failure
  • valve heart disease
  • NT pro-BNP

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Footnotes

  • Funding: the study was funded by clinical audit and research department of East and North Hertfordshire NHS trust.

  • Conflicts of interest: none declared.

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