Validez y utilidad del péptido ventricular natriurético tipo B (BNP) en la detección de disfunción ventricular izquierda en pacientes de alto riesgo en atención primaria / Validity and usefulness of B-type natriuretic peptide (BNP) for early detection of left ventricular dysfunction in high-risk patients in Primary Care

Objetivo: Determinar la validez y utilidad del BNP en atención primaria para detectar la disfunción ventricular en pacientes asintomáticos con alto riesgo de insuficiencia cardiaca (IC). Diseño: Estudio descriptivo prospectivo y multicéntrico de validación de prueba diagnóstica. Emplazamiento: Consultas de atención primaria de 7 centros de salud de la comunidad de Madrid. Participantes: Muestra consecutiva de 204 pacientes asintomáticos con riesgo elevado de presentar IC (estadios A y B de la American Heart Association). Mediciones principales: Se recogieron datos de la anamnesis, exploración física, electrocardiograma, factores de riesgo de IC y tratamiento actual. Se determinó el BNP en sangre venosa en la propia consulta mediante Triage BNP Test® (Biosite®) realizándose en las siguientes 72h un ecocardiograma (prueba de referencia). Comparamos los niveles de BNP según presencia o ausencia de disfunción ventricular, tipo (sistólica/diastólica) y grado. Se calcularon la sensibilidad, especificidad y los valores predictivos para el mejor punto de corte en la curva ROC. Resultados: Los valores de BNP fueron más altos (p<0,001) en pacientes con disfunción sistólica ventricular izquierda (DSVI). No se hallaron diferencias significativas para la disfunción diastólica. El mejor punto de corte para la detección de DSVI fue 71,00 pg/ml, siendo el área bajo la curva de 0,757 (IC 95%: 0,64-0,87). La sensibilidad fue del 75% (IC 95%: 50,66-99,34), especificidad 70,19% (62,81-77,57), valor predictivo positivo 20% (IC 95%: 9,05-30,95) y valor predictivo negativo 96,58% (IC 95%: 92,86-100), siendo la prevalencia de DSVI en esta población del 9,04%. Conclusiones: El BNP puede tener utilidad en el diagnóstico precoz de DSVI en pacientes de alto riesgo de IC en consultas de atención primaria debido a su alto VPN (> 96%)(AU)

Objective: The aim of this study was to determine the accuracy of BNP test for early diagnosis of left ventricular dysfunction in patients at high-risk for heart failure. Design: Cross-sectional descriptive study. Setting: 7 Primary Care Centres in Madrid (Spain). Participants: A consecutive sample of 204 consecutive asymptomatic patients with high risk for heart failure (Stages A-B, AHA/ACC Classification). Main measurements: BNP plasma levels were measured in the clinical setting using Triage BNP Test® (Biosite®) and an echocardiography was performed in the following 3 days in a single hospital unit as a reference standard. Plasma BNP levels were compared depending on the presence/absence of left ventricular dysfunction (LVD), type and severity degree. Sensitivity, specificity, positive and negative predictive values, and Área under the receiver operating characteristic curve (ROC) for BNP assay were calculated. Results: BNP values were significantly higher (P<.001) in patients with left ventricular systolic dysfunction (LVSD). No significant differences were found for diastolic dysfunction. The best cut-off value to discriminate the patients with LVSD was 71.00 pg/ml, with an Área under the ROC curve of 0.757 (95% CI 0.64-0.87). Sensitivity for LVD diagnosis was 75% (95% CI 50.66-99.34), specificity 70.19% (95% CI 62.81-77.57), positive predictive value (PPV) 20% (95% CI 9.05-30.95), and negative predictive value (NPV) 96.58% (95% CI 92.86-100), with LVSD prevalence of 9.04% in this population. Conclusions: BNP determinations are of value in diagnosing LVSD in a primary care setting, with similar sensitivities and specificities. Due to the high NPV is useful to rule-out patients for echocardiography(AU)

[Validity and usefulness of B-type natriuretic peptide (BNP) for early detection of left ventricular dysfunction in high-risk patients in primary care]. / Validez y utilidad del péptido ventricular natriurético tipo B (BNP) en la detección de disfunción ventricular izquierda en pacientes de alto riesgo en atención primaria.

OBJECTIVE: The aim of this study was to determine the accuracy of BNP test for early diagnosis of left ventricular dysfunction in patients at high-risk for heart failure. DESIGN: Cross-sectional descriptive study. SETTING: 7 Primary Care Centres in Madrid (Spain). PARTICIPANTS: A consecutive sample of 204 consecutive asymptomatic patients with high risk for heart failure (Stages A-B, AHA/ACC Classification). MAIN MEASUREMENTS: BNP plasma levels were measured in the clinical setting using Triage BNP Test(®) (Biosite(®)) and an echocardiography was performed in the following 3 days in a single hospital unit as a reference standard. Plasma BNP levels were compared depending on the presence/absence of left ventricular dysfunction (LVD), type and severity degree. Sensitivity, specificity, positive and negative predictive values, and Área under the receiver operating characteristic curve (ROC) for BNP assay were calculated. RESULTS: BNP values were significantly higher (P<.001) in patients with left ventricular systolic dysfunction (LVSD). No significant differences were found for diastolic dysfunction. The best cut-off value to discriminate the patients with LVSD was 71.00 pg/ml, with an Área under the ROC curve of 0.757 (95% CI 0.64-0.87). Sensitivity for LVD diagnosis was 75% (95% CI 50.66-99.34), specificity 70.19% (95% CI 62.81-77.57), positive predictive value (PPV) 20% (95% CI 9.05-30.95), and negative predictive value (NPV) 96.58% (95% CI 92.86-100), with LVSD prevalence of 9.04% in this population. CONCLUSIONS: BNP determinations are of value in diagnosing LVSD in a primary care setting, with similar sensitivities and specificities. Due to the high NPV is useful to rule-out patients for echocardiography.