Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population

Abstract

Objective: To evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) as a diagnostic and prognostic marker for systolic heart failure in the general population.Design: Study participants, randomly selected to be representative of the background population, filled in a heart failure questionnaire and underwent pulse and blood pressure measurements, electrocardiography, echocardiography, and blood sampling and were followed up for a median (range) period of 805 (60−1171) days.Setting: Participants were recruited from four randomly selected general practitioners and were examined in a Copenhagen university hospital.Patients: 382 women and 290 men in four age groups (50−59 (n  =  174); 60−69 (n  =  204); 70−79 (n  =  174); ⩾ 80 years (n  =  120)).Main outcome measures: Value of NT-proBNP in evaluating patients with symptoms of heart failure and impaired left ventricular (LV) systolic function; prognostic value of NT-proBNP for mortality and hospital admissions.Results: In 38 (5.6%) participants LV ejection fraction (LVEF) was ⩽ 40%. NT-proBNP identified patients with symptoms of heart failure and LVEF ⩽ 40% with a sensitivity of 0.92, a specificity of 0.86, positive and negative predictive values of 0.11 and 1.00, and area under the curve of 0.94. NT-proBNP was the strongest independent predictor of mortality (hazard ratio (HR)  =  5.70, p < 0.0001), hospital admissions for heart failure (HR  =  13.83, p < 0.0001), and other cardiac admissions (HR  =  3.69, p < 0.0001). Mortality (26 v 6, p  =  0.0003), heart failure admissions (18 v 2, p  =  0.0002), and admissions for other cardiac causes (44 v 13, p < 0.0001) were significantly higher in patients with NT-proBNP above the study median (32.5 pmol/l).Conclusions: Measurement of NT-proBNP may be useful as a screening tool for systolic heart failure in the general population.