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Clinical Chemistry 52: 1802-1808, 2006. First published July 27, 2006; 10.1373/clinchem.2005.064386
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(Clinical Chemistry. 2006;52:1802-1808.)
© 2006 American Association for Clinical Chemistry, Inc.

Point-of-Care Testing

Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure

Nadia Aspromonte1,a, Vincenzo Ceci1, Antonella Chiera1, Claudio Coletta1, Alessandra D’Eri2, Mauro Feola3, Prospero Giovinazzo2, Loredano Milani2, Federica Noventa2, Angela Beatrice Scardovi1, Augusto Sestili1 and Roberto Valle2

1 Heart Failure Unit and Department of Cardiology, Santo Spirito Hospital, Rome, Italy.
2 Department of Cardiology, S. Croce-Carle Hospital, Cuneo, Italy.
3 Heart Failure Unit, Department of Cardiology, Civic Hospital, San Donà di Piave (VE), Italy.

aAddress correspondence to this author at: Via Bonaventura Cerretti 18, I-00167 Rome, Italy. Fax 39-06-662950; E-mail naspromonte{at}yahoo.it.

Background: The early identification of patients at risk for the development of clinical heart failure (HF) is a new challenge in an effort to improve outcomes.

Methods: We prospectively evaluated whether the combination of brain natriuretic peptide (BNP) measurements (Triage BNP test, Biosite Diagnostics) and echocardiography would effectively stratify patients with new symptoms in a cost-effective HF program aimed at early diagnosis of mild HF. A total of 252 patients were referred by 100 general practitioners.

Results: Among the study population, the median BNP value was 78 ng/L (range, 5–1491 ng/L). BNP concentrations were lower among patients without heart disease [median 15 ng/L (range, 5–167 ng/L); n = 96] than among patients with confirmed HF [median, 165 ng/L (22–1491 ng/L); n = 157; Mann–Whitney U-test, 12.3; P <0.001]. Patients were grouped into diastolic dysfunction [BNP, 195 (223) ng/L], systolic dysfunction [BNP, 290 (394) ng/L], and both systolic and diastolic dysfunction [BNP, 776 (506) ng/L]. In this model, a cutoff value of 50 ng/L BNP increases the diagnostic accuracy in predicting mild HF, avoiding 41 echocardiograms per 100 patients studied, with a net saving of 14% of total costs.

Conclusions: Blood BNP concentrations, in a costeffective targeted screening, can play an important role in diagnosing mild HF and stratifying patients into risk groups of cardiac dysfunction.






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Copyright © 2006 by the American Association for Clinical Chemistry.