Screening for left ventricular dysfunction in the general population using natriuretic peptides and the electrocardiogram

One thousand three hundred and sixty subjects without a prior diagnosis of heart failure of left ventricular systolic dysfunction were randomly selected from a general population in Leicestershire. All subjects had a transthoracic echocardiogram performed as well as a standard 12 lead electrocardiogram (ECG). Serum levels of N-ANP, BNP and N-BNP were analyzed. There were twenty-eight cases (2.1% of the population) of left ventricular systolic dysfunction (LVSD), defined as a wall motion score index of >1.8. Serum levels of all three cardiac peptides were significantly elevated in subjects with LVSD. The prevalence of electrocardiographic abnormalities was also higher in the LVSD population. Using multivariate logistic regression analysis, ECG abnormalities, including a prolonged QRS duration, as well as N-ANP, BNP and N-BNP independently predicted LVSD. I then analyzed the performance of cardiac peptides and the ECG in diagnosing LVSD. All three cardiac peptides had high negative predictive values but low positive predictive values. The ECG performed less well as compared to cardiac peptides in diagnosing LVSD. BNP consistently performed better than N-ANP and N-BNP. Combining the ECG to any of the three cardiac peptides improved the diagnostic utility for LVSD..