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Electrocardiogram and B-type natriuretic peptide as screening tools for left ventricular systolic dysfunction in a population-based sample of 75-year-old men and women
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2004 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 3, 524-529 p.Article in journal (Refereed) Published
Abstract [en]

Background: Plasma concentration of B-type natriuretic peptide (BNP) has been suggested as a powerful screening tool for left ventricular systolic dysfunction. However, there are reports indicating that the 12-lead electrocardiogram (ECG) could be just as powerful. We aimed to evaluate the 12-lead ECG and BNP as screening tools for left ventricular systolic dysfunction in an elderly, unselected population.

Methods: In a randomly selected population-based sample of 75-year-old men and women (n = 407), diagnostic characteristics were evaluated for the ECG and plasma concentration of BNP to detect left ventricular systolic dysfunction.

Results: Sensitivity, specificity, and negative and positive predictive values for the ECG to detect left ventricular systolic dysfunction were 96%, 79%, 100%, and 26%, respectively. The corresponding values for the BNP (cut-off value 28 pg/mL) were 93%, 55%, 99%, and 13%. In participants without major abnormalities in the ECG, left ventricular systolic dysfunction was found in <1% (1/302), irrespective of BNP concentrations. In participants with abnormal ECGs, systolic dysfunction was more prevalent in persons with abnormal BNP concentrations than in those with normal concentrations (35% vs 3%, difference 32%, 95%CI for the difference 16%–44%)

Conclusions: In 75-year-old subjects both the ECG and the plasma concentration of BNP are highly efficient in excluding left ventricular systolic dysfunction. However, compared with the BNP, the ECG yields a lower number of false positive cases. In screening for left ventricular systolic dysfunction, the BNP has a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.

Place, publisher, year, edition, pages
2004. Vol. 148, no 3, 524-529 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93037DOI: 10.1016/j.ahj.2004.03.034,ISI: 000224339600024OAI: oai:DiVA.org:uu-93037DiVA: diva2:166393
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Left Ventricular Systolic Dysfunction in 75-year-old Men and Women: A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics
Open this publication in new window or tab >>Left Ventricular Systolic Dysfunction in 75-year-old Men and Women: A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Reduced performance of the left ventricle to eject blood – left ventricular systolic dysfunction (LVSD) – is a common predecessor of the heart failure syndrome. With or without symptoms, LVSD is associated with a poor prognosis. However, with adequate treatment, the development or progression of symptoms, the need for hospitalisation and mortality can all be reduced. In the present work, the occurrence of LVSD was evaluated by echocardiography in a community-based sample of 75-year-old men and women (n = 433). LVSD was a common condition, with a prevalence rate of 6.8%. In nearly half the participants with LVSD, there was no clinical evidence of heart failure.

Community-based screening for asymptomatic LVSD has been proposed as a strategy to reduce the incidence of heart failure. Because of the high costs and low availability, echocardiography is not a suitable screening tool. The plasma concentration of B-type natriuretic peptide (BNP) has been the most advocated screening tool. Another alternative is the standard 12-lead electrocardiogram (ECG). Both the ECG and BNP were effective in excluding LVSD in our 75-year-old community-based sample. However, compared with BNP, the ECG had considerably better specificity. In screening for LVSD, BNP had a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.

The left ventricular ejection fraction (LVEF) measured by echocardiography is a well-established index for describing left ventricular systolic function. The wall motion index (WMI) and the amplitude of mitral annulus motion (MAM) are suggested as alternative echocardiographic methods. Compared with MAM, the WMI had a more favourable agreement with the LVEF in our 75-year-old participants. Nonetheless, MAM was a strong predictor of mortality. MAM predicted the risk of all-cause and cardiac mortality independently of other risk factors. In addition, when it came to cardiac mortality, the predictive ability of MAM was independent of the LV function measured as the WMI.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 39
Keyword
Medical sciences, Aged, Heart Failure, Ventricular Function, Prevalence, Echocardiography, Electrocardiography, Natriuretic Peptide, Mortality, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-5793 (URN)91-554-6247-2 (ISBN)
Public defence
2005-06-04, Aulan, Gamla vårdgymnasiet, Ingång 21, Centrallasarettet, Västerås, 13:15
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Available from: 2005-05-13 Created: 2005-05-13Bibliographically approved

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Hedberg, PärNilsson, Göran

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