Utility of NT-proBNP as a rule-out test for left ventricular dysfunction in very old people with limiting dyspnoea: the Newcastle 85+ Study

详细信息    查看全文

• 作者：Joanna Collerton (2)
  Andrew Kingston (2)
  Fahad Yousaf (2)
  Karen Davies (2)
  Antoinette Kenny (3)
  Dermot Neely (4)
  Carmen Martin-Ruiz (2)
  Guy MacGowan (3) (5)
  Louise Robinson (2) (6)
  Thomas BL Kirkwood (2)
  Bernard Keavney (5) (7)
  
  2. Institute for Ageing and Health ; Newcastle University ; Newcastle upon Tyne ; UK
  3. Department of Cardiology ; Newcastle upon Tyne Hospitals NHS Foundation Trust ; Newcastle upon Tyne ; UK
  4. Department of Clinical Biochemistry ; Newcastle upon Tyne Hospitals NHS Foundation Trust ; Newcastle upon Tyne ; UK
  5. Institute of Genetic Medicine ; Newcastle University ; Newcastle upon Tyne ; UK
  6. Institute of Health and Society ; Newcastle University ; Newcastle upon Tyne ; UK
  7. Institute of Cardiovascular Sciences ; The University of Manchester ; Manchester ; UK
  
• 关键词：Systolic dysfunction ; Diastolic dysfunction ; Natriuretic peptides ; Sensitivity and specificity ; Aged ; 80 and over
• 刊名：BMC Cardiovascular Disorders
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：713 KB
• 参考文献：1. United Nations Department of Economic and Social Affairs. Population Division: World Population Ageing: 2009. [http://www.un.org/esa/population/publications/WPA2009/WPA2009_WorkingPaper.pdf]
  2. Wong, CY, Chaudhry, SI, Desai, MM, Krumholz, HM (2011) Trends in comorbidity, disability, and polypharmacy in heart failure. Am J Med 124: pp. 136-143 CrossRef
  3. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators / N Engl J Med 1992,327(10):685鈥?91.
  4. Tresch, DD (2000) Clinical manifestations, diagnostic assessment, and etiology of heart failure in elderly patients. Clin Geriatr Med 16: pp. 445-456 CrossRef
  5. Remme, WJ, McMurray, JJ, Hobbs, FD, Cohen-Solal, A, Lopez-Sendon, J, Boccanelli, A, Zannad, F, Rauch, B, Keukelaar, K, Macarie, C, Ruzyllo, W, Cline, C (2008) Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians. Eur Heart J 29: pp. 1739-1752 CrossRef
  6. Senni, M, Rodeheffer, RJ, Tribouilloy, CM, Evans, JM, Jacobsen, SJ, Bailey, KR, Redfield, MM (1999) Use of echocardiography in the management of congestive heart failure in the community. J Am Coll Cardiol 33: pp. 164-170 CrossRef
  7. NHS National Institute for Health and Care Excellence: Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. [http://www.nice.org.uk/guidance/cg108]
  8. McMurray, JJ, Adamopoulos, S, Anker, SD, Auricchio, A, Bohm, M, Dickstein, K, Falk, V, Filippatos, G, Fonseca, C, Gomez-Sanchez, MA, Jaarsma, T, Kober, L, Lip, GY, Maggioni, AP, Parkhomenko, A, Pieske, BM, Popescu, BA, Ronnevik, PK, Rutten, FH, Schwitter, J, Seferovic, P, Stepinska, J, Trindade, PT, Voors, AA, Zannad, F, Zeiher, A (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33: pp. 1787-1847 CrossRef
  9. Mant, J, Doust, J, Roalfe, A, Barton, P, Cowie, MR, Glasziou, P, Mant, D, McManus, RJ, Holder, R, Deeks, J, Fletcher, K, Qume, M, Sohanpal, S, Sanders, S, Hobbs, FD (2009) Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of different diagnostic strategies in primary care. Health Technol Assess 13: pp. 1-207
  10. Costello-Boerrigter, LC, Boerrigter, G, Redfield, MM, Rodeheffer, RJ, Urban, LH, Mahoney, DW, Jacobsen, SJ, Heublein, DM, Burnett, JC (2006) Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. J Am Coll Cardiol 47: pp. 345-353 CrossRef
  11. Raymond, I, Groenning, BA, Hildebrandt, PR, Nilsson, JC, Baumann, M, Trawinski, J, Pedersen, F (2003) The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart 89: pp. 745-751 CrossRef
  12. Redfield, MM, Rodeheffer, RJ, Jacobsen, SJ, Mahoney, DW, Bailey, KR, Burnett, JC (2004) Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study. Circulation 109: pp. 3176-3181 CrossRef
  13. Hogg, K, Swedberg, K, McMurray, J (2004) Heart failure with preserved left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol 43: pp. 317-327 CrossRef
  14. Yousaf, F, Collerton, J, Kingston, A, Kenny, A, Davies, K, Jagger, C, Robinson, L, Kirkwood, TB, Keavney, B (2012) Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study. Heart 98: pp. 1418-1423 CrossRef
  15. Collerton, J, Davies, K, Jagger, C, Kingston, A, Bond, J, Eccles, MP, Robinson, LA, Martin-Ruiz, C, von Zglinicki, T, James, OFW, Kirkwood, TBL (2009) Health and disease in 85聽year olds: baseline findings from the Newcastle 85+ cohort study. BMJ 339: pp. b4904 CrossRef
  16. Lang, RM, Bierig, M, Devereux, RB, Flachskampf, FA, Foster, E, Pellikka, PA, Picard, MH, Roman, MJ, Seward, J, Shanewise, JS, Solomon, SD, Spencer, KT, Sutton, MS, Stewart, WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18: pp. 1440-1463 CrossRef
  Echocardiography: Guidelines for Chamber Quantification.
  17. DeLong, ER, DeLong, DM, Clarke-Pearson, DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44: pp. 837-845 CrossRef
  18. Hildebrandt, P, Collinson, PO, Doughty, RN, Fuat, A, Gaze, DC, Gustafsson, F, Januzzi, J, Rosenberg, J, Senior, R, Richards, M (2010) Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. Eur Heart J 31: pp. 1881-1889 CrossRef
  19. Rutten, FH, Cramer, MJ, Zuithoff, NP, Lammers, JW, Verweij, W, Grobbee, DE, Hoes, AW (2007) Comparison of B-type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary disease. Eur J Heart Fail 9: pp. 651-659 CrossRef
  20. Wang, TJ, Evans, JC, Benjamin, EJ, Levy, D, LeRoy, EC, Vasan, RS (2003) Natural history of asymptomatic left ventricular systolic dysfunction in the community. Circulation 108: pp. 977-982 CrossRef
  21. Manzano, L, Escobar, C, Cleland, JG, Flather, M (2012) Diagnosis of elderly patients with heart failure. Eur J Heart Fail 14: pp. 1097-1103 CrossRef
  22. Vaes, B, de Ruijter, W, Gussekloo, J, Degryse, J (2009) The accuracy of plasma natriuretic peptide levels for diagnosis of cardiac dysfunction and chronic heart failure in community-dwelling elderly: a systematic review. Age Ageing 38: pp. 655-662 CrossRef
  23. Olofsson, M, Boman, K (2010) Usefulness of natriuretic peptides in primary health care: an exploratory study in elderly patients. Scand J Prim Health Care 28: pp. 29-35 CrossRef
  24. Chenevier-Gobeaux, C, Delerme, S, Allo, JC, Arthaud, M, Claessens, YE, Ekindjian, OG, Riou, B, Ray, P (2008) B-type natriuretic peptides for the diagnosis of congestive heart failure in dyspneic oldest-old patients. Clin Biochem 41: pp. 1049-1054 CrossRef
  25. Oudejans, I, Mosterd, A, Zuithoff, NP, Hoes, AW (2012) Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure. Age Ageing 41: pp. 309-316 CrossRef
  26. van Bemmel, T, Delgado, V, Bax, JJ, Gussekloo, J, Blauw, GJ, Westendorp, RG, Holman, ER (2010) Impact of valvular heart disease on activities of daily living of nonagenarians: the Leiden 85-plus study a population based study. BMC Geriatr 10: pp. 17 CrossRef
  27. Alehagen, U, Svensson, E, Dahlstrom, U (2007) Natriuretic peptide biomarkers as information indicators in elderly patients with possible heart failure followed over six years: a head-to-head comparison of four cardiac natriuretic peptides. J Card Fail 13: pp. 452-461 CrossRef
  28. Goode, KM, Clark, AL, Cleland, JG (2008) Ruling out heart failure in primary-care: the cost-benefit of pre-screening using NT-proBNP and QRS width. Int J Cardiol 130: pp. 426-437 CrossRef
  29. Park, HJ, Baek, SH, Jang, SW, Kim, DB, Shin, DI, Shin, WS, Kim, PJ, Jung, HB, Jung, HO, Seung, KB, Choi, KB (2010) Direct comparison of B-type natriuretic peptide and N-terminal pro-BNP for assessment of cardiac function in a large population of symptomatic patients. Int J Cardiol 140: pp. 336-343 CrossRef
  30. Landray, MJ, Lehman, R, Arnold, I (2000) Measuring brain natriuretic peptide in suspected left ventricular systolic dysfunction in general practice: cross-sectional study. BMJ 320: pp. 985-986 CrossRef
  31. Sivakumar, R, Wellsted, D, Parker, K, Lynch, M, Ghosh, P, Khan, SA (2006) Utility of N terminal pro brain natriuretic peptide in elderly patients. Postgrad Med J 82: pp. 220-223 CrossRef
  32. Krishnaswamy, P, Lubien, E, Clopton, P, Koon, J, Kazanegra, R, Wanner, E, Gardetto, N, Garcia, A, DeMaria, A, Maisel, AS (2001) Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction. Am J Med 111: pp. 274-279 CrossRef
  33. Mason, JM, Hancock, HC, Close, H, Murphy, JJ, Fuat, A, de Belder, M, Singh, R, Teggert, A, Wood, E, Brennan, G, Hussain, N, Kumar, N, Manshani, N, Hodges, D, Wilson, D, Hungin, AP (2013) Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. PLoS ONE 8: pp. e53560 CrossRef
  34. Tait, L, Roalfe, AK, Mant, J, Cowie, MR, Deeks, JJ, Iles, R, Barton, PM, Taylor, CJ, Derit, M, Hobbs, FD (2012) The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design. BMC Cardiovasc Disord 12: pp. 97 CrossRef
  35. Stewart, S, Jenkins, A, Buchan, S, McGuire, A, Capewell, S, McMurray, JJ (2002) The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 4: pp. 361-371 CrossRef
  36. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2261/14/128/prepub
  
• 刊物主题：Cardiology; Cardiac Surgery; Angiology; Blood Transfusion Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2261

文摘

Background Guidelines advocate using B-type natriuretic peptides in the diagnostic work-up of suspected heart failure (HF). Their main role is to limit echocardiography rates by ruling out HF/LV dysfunction where peptide level is low. Recommended rule-out cut points vary between guidelines. The utility of B-type natriuretic peptides in the very old (85+) requires further investigation, with optimal cut points yet to be established. We examined NT-proBNP's utility, alone and in combination with history of myocardial infarction (MI), as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. Methods Design: Cross-sectional analysis. Setting: Population-based sample; North-East England. Participants: 155 people (aged 87-89) with limiting dyspnoea. Measures: Dyspnoea assessed by questionnaire. Domiciliary echocardiography performed; LV systolic/diastolic function graded. NT-proBNP measured (Roche Diagnostics). Receiver operating characteristic analyses examined NT-proBNP's diagnostic accuracy for LV dysfunction. Results AUC for LVEF less than or equal to 50% was poor (0.58, 95% CI 0.49-0.65), but good for LVEF less than or equal to 40% (0.80, 95% CI 0.73-0.86). At ESC cut point (125ng/l), few cases of systolic dysfunction were missed (NPV 94-100%, depending on severity), but echocardiography (88%) and false positive rates (56-81 per 100 screened) were high. At NICE cut point (400ng/l), echocardiography (51%) and false positive rates (33-45) were lower; exclusionary performance was good for LVEF less than or equal to 40% (1 case missed per 100 screened, 15% of cases; NPV 97%), but poor for LVEF less than or equal to 50% (16 cases missed per 100 screened, 45% of cases; NPV 68%). Incorporating isolated moderate/severe diastolic dysfunction into target condition increased the proportion of cases missed (lower NPV), whilst improving case detection. Incorporating MI history as an additional referral prompt slightly reduced the number of cases missed at expense of higher echocardiography and false positive rates. Conclusions High echocardiography rates and poor exclusionary performance for mild degrees of systolic dysfunction and for diastolic dysfunction limit NT-proBNP's utility as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. Incorporating MI history as an additional echocardiography prompt yields no overall benefit compared to using NT-proBNP level alone.