COHORT STUDY OF PLASMA NATRIURETIC PEPTIDES FOR IDENTIFYING LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION IN PRIMARY-CARE

Objectives: To determine whether blood natriuretic peptide concentrati ons 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 echocard iographic assessment of left ventricular systolic function in a genera l practice population. Setting: Practices in Western District of Glasg ow audit group. Subjects: 134 long term survivors of myocardial infarc tion recalled for echocardiography as part of a primary care secondary prevention audit. Main outcome measures: Area under the receiver oper ating curve for brain natriuretic peptide and N-terminal atrial natriu retic peptide. Results: Brain natriuretic peptide was of some diagnost ic utility in identifying the minority of subjects with severe left ve ntricular dysfunction (area under curve = 0.73) but was unable to disc riminate between patients with moderately severe dysfunction and those with preserved left ventricular function (area under curve for modera te or severe dysfunction = 0.54). The corresponding values for N-termi nal atrial natriuretic peptide for severe and moderate or severe dysfu nction were 0.55 and 0.56 respectively. Conclusions: Blood natriuretic peptide concentrations are not useful in identifying important left v entricular systolic dysfunction in stable survivors of myocardial infa rction.