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Data From the Heart and Soul Study

David C. M. Corteville, MD; Kirsten Bibbins-Domingo, PhD, MD; Alan H. B. Wu, PhD; Sadia Ali, MD, MPH; Nelson B. Schiller, MD; Mary A. Whooley, MD

Arch Intern Med. 2007;167(5):483-489.

Background  N-terminal pro–B-type natriuretic peptide (NT-proBNP) testing is useful for diagnosing acute decompensated heart failure. Whether NT-proBNP can be used to detect ventricular dysfunction in patients with stable coronary heart disease (CHD) and no history of heart failure is unknown.

Methods  We measured NT-proBNP levels and performed transthoracic echocardiography in 815 participants from the Heart and Soul Study, who had stable CHD and no history of heart failure. We hypothesized that NT-proBNP concentrations lower than 100 pg/mL would rule out ventricular dysfunction and concentrations higher than 500 pg/mL would identify ventricular dysfunction. We calculated sensitivities, specificities, likelihood ratios, and areas under the receiver operating characteristic curves for NT-proBNP as a case-finding instrument for systolic and diastolic dysfunction.

Results  Of the 815 participants with no history of heart failure, 68 (8%) had systolic dysfunction defined as a left ventricular ejection fraction of 50% or lower. Of the 730 participants for whom the presence or absence of diastolic dysfunction could be determined, 78 (11%) had diastolic dysfunction defined as a pseudonormal or restrictive filling pattern. The overall area under the receiver operating characteristic curve for detecting systolic or diastolic dysfunction was 0.78 (95% confidence interval, 0.74-0.82). Likelihood ratios were 0.28 for NT-proBNP concentrations lower than 100 pg/mL, 0.95 for concentrations between 100 and 500 pg/mL, and 4.1 for concentrations higher than 500 pg/mL. A test result lower than 100 pg/mL reduced the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 6%. A test result higher than 500 pg/mL increased the probability of ventricular dysfunction from a pretest probability of 18% to a posttest probability of 47%. A test result between 100 and 500 pg/mL did not change the probability of ventricular dysfunction.

Conclusion  In patients with stable CHD and no history of heart failure, NT-proBNP levels lower than 100 pg/mL effectively rule out ventricular dysfunction, with a negative likelihood ratio of 0.28.

Author Affiliations: Departments of Medicine (Drs Corteville, Bibbins-Domingo, Schiller, and Whooley), Epidemiology and Biostatistics (Drs Bibbins-Domingo and Whooley), and Laboratory Medicine (Dr Wu), University of California, San Francisco; San Francisco General Hospital (Drs Bibbins-Domingo and Wu); and Department of Veterans Affairs Medical Center, San Francisco (Drs Ali, Schiller, and Whooley).

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