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European Heart Journal Advance Access originally published online on November 18, 2005
European Heart Journal 2006 27(4):447-453; doi:10.1093/eurheartj/ehi657
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

N-terminal brain natriuretic peptide as a screening tool for heart failure in the pacemaker population

Simon D.R. Thackray*, Klaus Witte, Justin Ghosh, Nikolay Nikitin, Anne Anderson, Alan Rigby, Kevin Goode, Andrew L. Clark and John G.F. Cleland

Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, Cottingham, East Yorkshire, UK

Received 11 November 2004; revised 11 October 2005; accepted 27 October 2005; online publish-ahead-of-print 18 November 2005.

* Corresponding author. Tel: +44 1482 624073; fax: +44 1482 624084. E-mail address: simonthackray{at}hotmail.com

Aims Assessment of N-terminal brain natriuretic peptide (NT-BNP) as a screening tool for heart failure in patients with a permanent pacemaker.

Methods and results Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT-BNP. Analysis was performed on 261 patients (132 DDD, 121 VVI, eight others), mean age 73±12 years, range 34–99 years. Seventy two subjects (27%) had heart failure as defined by left ventricular ejection fraction (LVEF) ≤40% and symptoms of heart failure (NYHA class II, III, or IV). Screening with NT-BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve (AUC) 0.76, P<0.001, 95% CI 0.69–0.83]. This increased in subjects with a DDD type pacemaker (sensitivity 80%, specificity 66%, AUC=0.8, CI 0.7–0.90) and reduced in subjects with a VVI type pacemaker (sensitivity 66%, specificity 61%, AUC 0.68 CI 0.57–0.78).

Conclusion Symptoms of heart failure are common in patients with pacemakers. Screening with NT-BNP is feasible and assists in the detection of important cardiac co-morbidity, particularly in patients with a DDD type pacemaker.

Key Words: Pacemaker • Heart failure • Screening • NT-BNP


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