Plasma N-terminal pro-brain natriuretic peptide and the ECG in the assessment of left-ventricular systolic dysfunction in a high risk population

Aims To examine the value of N-terminal pro-brain natriuretic peptide, abno rmal electrocardiogram and other baseline clinical and laboratory variables in identifying patients with left ventricular systolic dysfunction in a hi gh risk population. Methods and Results We studied 243 patients (129 male, median age 73 years, range 20-94) referred for echocardiography. The relationship between left ventricular wall motion index and log N-terminal pro-brain natriuretic pept ide, log creatinine, electrocardiogram, age, history of hypertension, histo ry of ischaemic heart disease, gender, valvular disease and current drug th erapy was examined using regression analysis. There was a strong correlatio n between N-terminal pro-brain natriuretic peptide and left ventricular wal l motion index for the whole population (r = -0.624, P<0.001) and in those receiving diuretic +/- angiotensin converting enzyme inhibitor (r -0.661, P <0.005) and in those receiving neither (r = -0.584, P<0.005). On multiple r egression analysis, log N-terminal pro-brain natriuretic peptide (P<0.001), age (P = 0.015), current diuretic (P = 0.002) or angiotensin converting en zyme inhibitor use (P = 0.001) and male gender (P = 0.026) were independent ly associated with a low left ventricular wall motion index. Log N-terminal pro-brain natriuretic peptide alone (R-2 = 39%) was a better predictor of left ventricular wall motion index than any other single or combination of factors. Plasma N-terminal pro-brain natriuretic peptide > 275 pmol l(-1) p redicted left ventricular wall motion index less than or equal to 1.2 with a sensitivity of 93.8%, a specificity of 55% and a negative predictive valu e of 93%. Left ventricular function was impaired in 18/36 patients with a n ormal electrocardiogram, in all of whom N-terminal pro-brain natriuretic pe ptide was >275 fmol ml(-1). Conclusion Of the variables studies, N-terminal pro-brain natriuretic pepti de had the strongest correlation with reduced left ventricular wall motion index. The electrocardiogram had a poor predictive value for left ventricul ar systolic dysfunction in this population. Plasma N-terminal pro-brain nat riuretic peptide can usefully predict patients with a reduced left ventricu lar wall motion index in whom echocardiographic examination may be appropri ate. (C) 1999 The European Society of Cardiology.