Ability of Brain Natriuretic Peptide Tests and Homocysteine to Exclude Congestive Heart Failure~!2009-12-07~!2010-01-05~!2010-02-04~!

Abstract

Among the most promising tests for early detection of congestive heart failure (CHF) are brain natriuretic pep- tides (BNPs), but it is unclear if homocysteine can aid in differentiating those with and without disease. We attempt to use a combination of tests to reduce the need for echocardiography without missing any cases of CHF. We compared 50 CHF patients with an ejection fraction of less than 60%, to 100 patients with non-specific symptoms but with a normal echocardiogram. After setting sensitivity at 100%, specificities for BNP, amino-terminal probrain natri- uretic peptide (NT-pro BNP), and homocysteine were 34%, 28% and 36% respectively. Combinations of two tests if ho- mocysteine was included increased the specificity to 56%. The AUC for BNP and NT-proBNP were not significantly dif- ferent (92.8 and 95.9, respectively) whereas the AUC for BNP and NT-proBNP tests were superior to homocysteine (83.2). Compared with performing echocardiography in all patients, savings were dependent on the pretest probability. At a 1% pretest probability of CHF, savings were 44.5% while using a combination of NT-proBNP with homocysteine test. Homocysteine can be used in combination with either of the BNPs to decrease costs of early detection of CHF.