Natriuretic peptide vs. clinical information for diagnosis of left ventricular systolic dysfunction in primary care
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Natriuretic peptide vs. clinical information for diagnosis of left ventricular systolic dysfunction in primary care. / Koschack, Janka; Scherer, Martin; Lüers, Claus; Kochen, Michael M; Wetzel, Dirk; Kleta, Sibylle; Pouwels, Claudia; Wachter, Rolf; Herrmann-Lingen, Christoph; Pieske, Burkert; Binder, Lutz.
in: BMC FAM PRACT, Jahrgang 9, 2008, S. 14.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Natriuretic peptide vs. clinical information for diagnosis of left ventricular systolic dysfunction in primary care
AU - Koschack, Janka
AU - Scherer, Martin
AU - Lüers, Claus
AU - Kochen, Michael M
AU - Wetzel, Dirk
AU - Kleta, Sibylle
AU - Pouwels, Claudia
AU - Wachter, Rolf
AU - Herrmann-Lingen, Christoph
AU - Pieske, Burkert
AU - Binder, Lutz
PY - 2008
Y1 - 2008
N2 - BACKGROUND: Screening of primary care patients at risk for left ventricular systolic dysfunction by a simple blood-test might reduce referral rates for echocardiography. Whether or not natriuretic peptide testing is a useful and cost-effective diagnostic instrument in primary care settings, however, is still a matter of debate.METHODS: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, clinical information, and echocardiographic data of left ventricular systolic function were collected in 542 family practice patients with at least one cardiovascular risk factor. We determined the diagnostic power of the NT-proBNP assessment in ruling out left ventricular systolic dysfunction and compared it to a risk score derived from a logistic regression model of easily acquired clinical information.RESULTS: 23 of 542 patients showed left ventricular systolic dysfunction. Both NT-proBNP and the clinical risk score consisting of dyspnea at exertion and ankle swelling, coronary artery disease and diuretic treatment showed excellent diagnostic power for ruling out left ventricular systolic dysfunction. AUC of NT-proBNP was 0.83 (95% CI, 0.75 to 0.92) with a sensitivity of 0.91 (95% CI, 0.71 to 0.98) and a specificity of 0.46 (95% CI, 0.41 to 0.50). AUC of the clinical risk score was 0.85 (95% CI, 0.79 to 0.91) with a sensitivity of 0.91 (95% CI, 0.71 to 0.98) and a specificity of 0.64 (95% CI, 0.59 to 0.67). 148 misclassifications using NT-proBNP and 55 using the clinical risk score revealed a significant difference (McNemar test; p < 0.001) that was based on the higher specificity of the clinical risk score.CONCLUSION: The evaluation of clinical information is at least as effective as NT-proBNP testing in ruling out left ventricular systolic dysfunction in family practice patients at risk. If these results are confirmed in larger cohorts and in different samples, family physicians should be encouraged to rely on the diagnostic power of the clinical information from their patients.
AB - BACKGROUND: Screening of primary care patients at risk for left ventricular systolic dysfunction by a simple blood-test might reduce referral rates for echocardiography. Whether or not natriuretic peptide testing is a useful and cost-effective diagnostic instrument in primary care settings, however, is still a matter of debate.METHODS: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, clinical information, and echocardiographic data of left ventricular systolic function were collected in 542 family practice patients with at least one cardiovascular risk factor. We determined the diagnostic power of the NT-proBNP assessment in ruling out left ventricular systolic dysfunction and compared it to a risk score derived from a logistic regression model of easily acquired clinical information.RESULTS: 23 of 542 patients showed left ventricular systolic dysfunction. Both NT-proBNP and the clinical risk score consisting of dyspnea at exertion and ankle swelling, coronary artery disease and diuretic treatment showed excellent diagnostic power for ruling out left ventricular systolic dysfunction. AUC of NT-proBNP was 0.83 (95% CI, 0.75 to 0.92) with a sensitivity of 0.91 (95% CI, 0.71 to 0.98) and a specificity of 0.46 (95% CI, 0.41 to 0.50). AUC of the clinical risk score was 0.85 (95% CI, 0.79 to 0.91) with a sensitivity of 0.91 (95% CI, 0.71 to 0.98) and a specificity of 0.64 (95% CI, 0.59 to 0.67). 148 misclassifications using NT-proBNP and 55 using the clinical risk score revealed a significant difference (McNemar test; p < 0.001) that was based on the higher specificity of the clinical risk score.CONCLUSION: The evaluation of clinical information is at least as effective as NT-proBNP testing in ruling out left ventricular systolic dysfunction in family practice patients at risk. If these results are confirmed in larger cohorts and in different samples, family physicians should be encouraged to rely on the diagnostic power of the clinical information from their patients.
KW - Aged
KW - Echocardiography
KW - Female
KW - Germany
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Natriuretic Peptide, Brain
KW - Primary Health Care
KW - ROC Curve
KW - Reproducibility of Results
KW - Risk Assessment
KW - Risk Factors
KW - Sensitivity and Specificity
KW - Ventricular Dysfunction, Left
U2 - 10.1186/1471-2296-9-14
DO - 10.1186/1471-2296-9-14
M3 - SCORING: Journal article
C2 - 18298821
VL - 9
SP - 14
JO - BMC PRIM CARE
JF - BMC PRIM CARE
SN - 1471-2296
ER -
