Copyright © 1999 by the European Society of Cardiology.
Plasma N-terminal pro-brain natriuretic peptide and the ECG in the assessment of left-ventricular systolic dysfunction in a high risk population
Department of Medicine and Therapeutics, University of Leicester, Leicester, U.K.
revised May 4, 1999; accepted May 5, 1999
Abstract
Aims To examine the value of N-terminal pro-brain natriuretic peptide, abnormal electrocardiogram and other baseline clinical and laboratory variables in identifying patients with left ventricular systolic dysfunction in a high 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 peptide, log creatinine, electrocardiogram, age, history of hypertension, history of ischaemic heart disease, gender, valvular disease and current drug therapy was examined using regression analysis. There was a strong correlation between N-terminal pro-brain natriuretic peptide and left ventricular wall 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 regression analysis, log N-terminal pro-brain natriuretic peptide (P<0·001), age (P=0·015), current diuretic (P=0·002) or angiotensin converting enzyme inhibitor use (P=0·001) and male gender (P=0·026) were independently associated with a low left ventricular wall motion index. Log N-terminal pro-brain natriuretic peptide alone (R2=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>275pmoll–1predicted left ventricular wall motion index 
1·2 with a sensitivity of 93·8%, a specificity of 55% and a negative predictive value of 93%. Left ventricular function was impaired in 18/36 patients with a normal electrocardiogram, in all of whom N-terminal pro-brain natriuretic peptide was >275fmolml–1.
Conclusion Of the variables studies, N-terminal pro-brain natriuretic peptide had the strongest correlation with reduced left ventricular wall motion index. The electrocardiogram had a poor predictive value for left ventricular systolic dysfunction in this population. Plasma N-terminal pro-brain natriuretic peptide can usefully predict patients with a reduced left ventricular wall motion index in whom echocardiographic examination may be appropriate.
Key Words: Heart failure, plasma, brain natriuretic peptide, wall motion index, chemiluminescence.
f1 Correspondence: Dr L. L. Ng, Dept. of Medicine & Therapeutics, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, U.K.
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