Received on November 26, 2005
Accepted on June 26, 2006

Point-of-Care Testing

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

¹ Heart Failure Unit and Department of Cardiology, Santo Spirito Hospital, Italy
² Department of Cardiology, Ospedale Civile, Cuneo, Italy
³ Heart Failure Unit, Cardiology Department, San Donà di Piave Hospital, Italy

^* To whom correspondence should be addressed. 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 to 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 subjects 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 cost-effective targeted screening, can play an important role in diagnosing mild HF and stratifying patients into risk groups of cardiac dysfunction.