The Role of N-Terminal Pro-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure: The PROBE-HF Study

Abstract. Background.  Screening for asymptomatic left ventricular dysfunction (ALVD) in patients at risk for heart failure (HF) can affect clinical management. The aim of the present study is to examine the role of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the diagnosis of ALVD in patients with hypertension and diabetes from primary care. Methods and Results.  A total of 1012 patients with hypertension and/or diabetes and no symptoms or signs of HF were assessed by NT-pro-BNP assay and echocardiography. Diastolic dysfunction was present in 368 of 1012 patients (36.4%): 327 (32.4%) with mild diastolic dysfunction and 41 (4%) with a moderate to severe diastolic dysfunction. Systolic dysfunction was present in 11 of 1012 patients (1.1%). NT-pro-BNP levels were 170±206 and 859±661 pg/mL, respectively, in diastolic and systolic dysfunction and 92±169 in healthy patients (P<.0001). Pooling moderate to severe diastolic with systolic dysfunction, a total of 52 patients (5.1%) were obtained: the best cutoff of NT-pro-BNP was 125 pg/mL (men younger than 67 years: sensitivity, 87.5%; specificity, 92.7%; negative predictive value [NPV], 99.5%; positive predictive value [PPV], 33.3%; women younger than 67 years: sensitivity, 100%; specificity, 84.1%; NPV, 100%; PPV, 33.3%; men 67 years or older: sensitivity, 100%; specificity, 77.1%; NPV, 100%; PPV, 32.5%; women 67 years or older: sensitivity, 100%; specificity, 59.9%; NPV, 100%; PPV, 23%). Conclusions.  The prevalence of ALVD in patients at risk for HF is 5.1%. Because of its excellent NPV, NT-pro-BNP assessment can be used by general practitioners to rule out ALVD in hypertensive or diabetic patients.—Betti I, Castelli G, Barchielli A, et al. The role of N-terminal Pro-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail. 2009;15:377–384.