Diagnosis Of Chronic Heart Failure Research Articles

Occurrence and impact of chronic obstructive pulmonary disease in elderly patients with stable heart failure

The coexistence of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increases with age. The occurrence, prognosis and therapeutic implications of concurrent COPD in elderly patients with CHF were investigated. One hundred and eighteen consecutive patients, ≥ 65 years old with ≥ 10 pack/years of smoking and with a verified diagnosis of CHF in stable condition, were enrolled. They were followed for a mean of 1029 (range 758-1064) days. All patients had spirometry and the diagnosis and classification of COPD were made according to Global Initiative for Chronic Obstructive Lung Disease guidelines. The mean occurrence of COPD was 30% (90% confidence interval: 24-37%). At baseline in patients with CHF and COPD, there was a shorter 6-min walk distance, lower arterial oxygen tension, glomerular filtration rate and higher N-terminal pro-B-type natriuretic peptide (all P < 0.05). The prescription of CHF therapies, including β-blockers, was similar in the two groups. After follow up, the presence of COPD in patients with CHF did not appear to influence survival. COPD is relatively frequent in elderly patients with CHF. COPD did not alter survival.

The 2012 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Acute and Chronic Heart Failure

The 2012 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heart failure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF.

PLASMA METABOLOMICS REVEALS NOVEL METABOLIC MARKERS OF CHRONIC HEART FAILURE

ObjectivesChronic heart failure (CHF) is a progressive clinical syndrome characterised by inability of the heart to adequately pump blood to meet metabolic demands of the body. There is intense interest...

Relationship between recommended chronic heart failure treatments and mortality over 8 years in real-world conditions: a pharmacoepidemiological study

We previously reported that chronic heart failure (CHF) treatments reduce the duration of hospitalisation, even in elderly patients. The present study aimed to determine whether CHF treatment also provides long-term benefits in terms of reduced mortality at 8 years. A cohort of 281 patients who were admitted to a French teaching hospital with a main diagnosis of CHF were followed through the health insurance databases for 1 year and through the national mortality database for 8 years. Diuretics (236 patients, 84 %) and angiotensin-converting enzyme (ACE) inhibitors (193 patients, 69 %) were the most-frequently prescribed medications. The median duration of survival was 46 months. Mortality rates were significantly lower for patients administered beta-blockers (59 %) and statins (56 %) than for patients not exposed to these drugs (82 %, p < 0.001 and 78 %, p = 0.001 respectively). No significant differences in mortality were observed for spironolactone, diuretics or ACE inhibitors. After adjustment, beta-blocker treatment remained associated with a significantly lower risk of mortality (hazard ratio, HR = 0.54 [0.34-0.84]). After adjustment, the use of two or three CHF drugs was associated with longer survival (HR = 0.53 [0.36-0.77]) than the use of zero or one CHF drug. Statins were also associated with longer survival after adjustment (HR = 0.53 [0.31-0.89]). In patients 75 years of age or older (n = 73), only beta-blocker treatment was associated with a significantly lower risk of mortality (HR = 0.31 [0.16-0.63]) in multivariate analysis. The use of beta-blockers was associated with better survival rates. The use of statins was also associated with better survival at 8 years. Randomised controlled trials are required to confirm these observations.

Discontinuation of beta-blockers in cardiovascular disease: UK primary care cohort study

AimsThe present study aims to investigate patterns of beta-blocker usage in a national primary care cohort. Methods and resultsThis is a retrospective cohort study utilising the UK General Practice Research Database from 2004 to 2008. Inclusion criteria were (i) a first diagnosis of chronic heart failure (CHF), myocardial infarction (MI) or angina, and (ii) first-ever prescription of beta-blocker on or after 1st April 2004. Outcome measures were discontinuation of beta-blockers over time, initiation dosages, titration patterns, incidence of adverse events (AEs) and associated prescribing actions.A total of 12,493 patients (68.0% male; mean age 58.0±SD 17.6years) were included. Of these, 27% had discontinued beta-blockers within 1year of initiation, increasing to 39% by 2years and 50% by 3years. Persistence appeared to be greater in the MI cohort compared with angina or CHF cohorts. Beta-blocker dose at initiation averaged approximately 33% of guideline recommended target, rising to 40% in those who continued with therapy. Dyspnoea, fatigue and dizziness were the most common incident AEs at 98, 53 and 49 per 1000 patient years, with little difference between indications. ConclusionA quarter of patients with cardiovascular disease who are commenced on a beta-blocker are no longer taking the drug by one year. This rises to 50% by three years, a finding that is consistent irrespective of whether the prescription is for prognostic (CHF or post MI) or symptomatic (angina) benefit. There is an urgent need to understand and address the prescribing difficulties of beta-blockers in these at-risk patients.

011 HbA1c and mortality in diabetic individuals with heart failure: an observational cohort study

Background Controversy exists regarding the importance of glycaemic control in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) based on conflicting reports that had used a single baseline HbA1c. Objective To examine the relationship between the mean of all HbA1c measures after CHF diagnosis and outcome in a large cohort of T2DM patients with incident CHF. Design Retrospective, observational cohort study. Setting Tayside, Scotland. Patients T2DM patients with incident CHF between 1993 and 2010. Measurement A weighted mean HbA1c was calculated using all available HbA1c measures following CHF diagnosis and patients were grouped into five categories of HbA1c (≤6%, >6–≤7%, >7–≤8%, >8–≤9% and >9%). We subsequently compared diet and drug treated populations. The relationship between mean HbA1c and all-cause deaths after CHF diagnosis was assessed. Results 795 patients with T2DM met study criteria. Median follow-up of 3.8 years saw 491 (61.8%) deaths. Cox regression model, adjusted for all other significant predictors, with the middle HbA1c category (>7–≤8%) as the reference, showed a U shaped relationship between HbA1c and outcome. (<6% [HR 95% CI 1.78 (1.26 to 2.52)]; >6–≤7% [1.29 (1.01 to 1.66)] and >9% [1.38 (1.03 to 1.84)]. We found a similar relationship in the drug treated sub-group. However in the diet only group, low HbA1c was associated with the lowest risk of death (≤7% [0.17 (0.07 to 0.39)]). Conclusions In patients with T2DM and CHF, our observational study shows that in drug treated patients there was a U shaped relationship between HbA1c and mortality with the lowest mortality risk in patients with modest glycaemic control (HbA1c, >7–≤9%). However in diet treated patients, lower HbA1c was associated with lower mortality risk.

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

BackgroundChronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors.To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital.MethodPatients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF.ResultsAlthough several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate.ConclusionThe vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

The association between mild cognitive impairment and self-care activity in community dwelling adult patients who have a diagnosis of chronic heart failure: a systematic review.

Review question/objective The objective of the review is to synthesise the best available evidence for an association between mild cognitive impairment and self-care activity in patients who have been diagnosed with chronic heart failure. The review question is: What is the evidence for an association between mild cognitive impairment and self-care activity, measured in one or more of the self-care domains related to heart failure in community dwelling adult patients who have a diagnosis of chronic heart failure? Inclusion criteria Types of participants Studies will include community dwelling adult patients (18 years and above) who have a diagnosis of chronic heart failure, at any stage of the New York Heart Association (NYHA) Classification of Heart Failure.35 Patients will be included regardless of gender, age, ethnic origin or any co-morbidity. Focus of the Review: The focus of the review is the epidemiological association between mild cognitive impairment (considered the presupposed risk factor) and self-care activity in the context of heart failure (considered the outcome). For the purposes of this review, mild cognitive impairment will be defined as evidence of impairment on a validated screening tool or diagnostic battery in individuals who do not have cognitive impairment that is severe enough to interfere with their basic activities of daily living. Studies that use validated instruments to measure cognitive function or impairment (as presupposed risk factor) will be considered for inclusion in this review. All included studies must also measure self-care capability or activities as outcomes of interest. This may be performed using validated tools, or more simple measures (such as percentage of missed medications). Self-care will include management of diet (including healthy diet, salt and fluid intake), medicines management, avoidance of risk factors for disease progression/deterioration, and symptom awareness and management.

To determine the value of the NT-proBNP levels in patients who were diagnosed as chronic heart failure

ObjectiveTo determine the value of NT-proBNP levels in patients who were diagnosed as chronic heart failure.MethodsSerum NT-proBNP levels were measured in 70 patients who had been diagnosed to have CHF,...

140 Exploring Heart Failure-Related Emergency Department Visits and Hospitalizations From the Patient Perspective

Low-income African-Americans with heart failure represent a vulnerable population that has poor clinical outcomes despite high rates of emergency department (ED) visits and hospitalizations. The patient-level factors that contribute to these high rates of health service utilization have not been clearly defined. The purpose of this study is to identify, among low-income African-Americans, patient-perceived medical and social challenges that contribute to poor heart failure-related clinical outcomes, avoidable ED visits, and avoidable hospitalizations. Semi-structured interviews were conducted with a convenience sample of African-American patients who presented to a high volume, inner-city, county-owned, teaching ED in Los Angeles. Patients were eligible for the study if they were being admitted to the hospital for a chronic heart failure exacerbation. The patients were interviewed in the ED or inpatient medicine ward. The interview incorporated questions to examine patients' experiences and beliefs regarding heart failure-related quality of life, general heart failure knowledge, patient-provider interactions, medication adherence, self-management skills, and health system navigation. Two follow-up interviews were performed by telephone with each study participant at 7 days and 30 days following discharge. The follow-up interviews included additional questions regarding patient satisfaction, the quality and comprehension of hospital discharge instructions, ease of new medication regimen, and outpatient follow-up care. Audio files of the interviews were transcribed and organized using Atlas.ti software. Themes were coded using grounded theory methods. Theme saturation was pre-defined as the identification of recurrent themes in greater than 70% of the interviews. Preliminary interviews were conducted with 7 African-American patients with a hospital admission diagnosis of chronic heart failure. The patients consisted of 5 men and 2 women, whose age ranged from 47 to 65 years old. One patient had Medicare insurance and the remaining patients were uninsured. All of the patients had a New York Heart Association classification of 3. Five salient themes were consistently identified that were believed by the patients to contribute to poor health and increased use of hospital-based care: 1) Competing demands due to economic or social stressors which results in medication noncompliance, 2) Dietary challenges and lack of nutrition education, 3) Poor patient-provider communication and/or interactions, 4) Unwarranted judgment by health providers and/or family, and 5) Lack of social support to make and maintain healthy lifestyle changes. All of the patients stated that they had adequate access to health care providers and heart failure related information. African-Americans with heart failure represent a vulnerable population that is subject to poor health outcomes despite costly health service utilization. However, lack of access to medical care is not a patient-perceived contributor to poor health. This qualitative study suggests that social and community factors may have a greater than expected impact on health behaviors and outcomes. The results from this study will be used to develop a community-based intervention to decrease avoidable ED visits and hospitalizations among low-income African-Americans with heart failure.

The clinical significance of urinary B-type natriuretic peptide assay for the diagnosis of chronic heart failure

Objective To investigate the value of urinary BNP for diagnosis of chronic heart failure (CHF). Methods The levels of Urinary BNP and plasma BNP were measured by microparticle enzyme immunoassay (MEIA) in 83 patients with CHF and 30 control subjects. The heart function was classified according to the NYHA criteria. Left ventricular ejection fractions (LVEF) were measured by echocardiology. Results The level of urinary BNP in patients with CHF was[90. 0(38. 3 -209. 5 )]ng/L and the level of plasma BNP was[680. 0 ( 289. 7 - 1543.5)]ng/L, both of them were much higher than those in healthy subjects,[17. 0 ( 13.0 - 33. 0)]ng/L and[84. 5 ( 56. 0 - 158.0 )]ng/L, respectively (P＜0. 01 ). The concentrations of urinary BNP increased gradually with more severe symptoms ( NYHA cl ass Ⅰ -ⅣV ). The level of urinary BNP was positively correlated with NYHA class ( r = 0. 742, P ＜ 0. 01 )and the level of plasma BNP (r =0. 842,P ＜0. 01 ) while negatively related with LVEF (r = -0. 801 ,P ＜0. 01 ). The level of urinary BNP in patients with LVEF ＜ 40％ was[143.0 ( 85. 0 - 258.0)]ng/L , which was much higher than that in patients with LVEF≥40％ ,[31.5( 17.3 -38. 8)]ng/L, (P ＜0. 01 ). At a decision threshold of 36. 5 ng/L, the urine BNP assay demonstrated a clinical sensitivity and specificity of 84％ and 80％ ,respectively. In this study,the area under the curve(AUC) was 0. 905. Conclusion Urinary BNP is a new candidate marker for the diagnosis of CHF,it provides a similar accuracy with plasma BNP. Key words: Heart failure; Natriuretic peptide, brain; Urinalysis

A Case of Chronic Heart Failure with Sleep-Disordered Breathing Successfully Treated by Cardiac Resynchronization and Continuous Positive Airway Pressure

A 68-year-old man, who had previously received a diagnosis of chronic heart failure (CHF) due to dilated cardiomyopathy and who had atrial fibrillation with advanced atrioventricular block treated by single-chamber ventricular pacing (VVI mode), was admitted to our hospital owing to CHF exacerbation despite receiving medical treatment. We applied cardiac resynchronization therapy (CRT) because his NYHA classification was class III and he also had ventricular mechanical dyssynchrony. Overnight polysomnography (PSG) before CRT implantation revealed severe sleep-disordered breathing (SDB), including central sleep apnea with Cheyne-Stokes respiration (CSR-CSA) as indicated by an apnea-hypopnea index (AHI) of 60.6/h. After 6 months from the CRT implantation, B-type natriuretic peptide level (pg/ml) decreased from 299 to 150, VE/VCO2 slope decreased from 42.2 to 27.7, and oscillatory ventilation disappeared on a cardiopulmonary exercise test. Six months later, although his AHI was high (49.5/h), CSR-CSA level was markedly decreased. Therefore, we conducted titration by continuous positive airway pressure (CPAP). Thereafter, when the SDB events had been sufficiently controlled, his clinical course was satisfactory. In this case, PSG before and after CRT implantation was a method of evaluating the efficacy of CRT, and also assisted in the selection of the appropriate therapy, in this case, CPAP. Here, we describe the assessment of SDB and successful treatment by CRT and positive airway pressure devices in CHF patients.

The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home‐ vs. clinic‐based management of chronic heart failure patients

To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patient's own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 12-18 months of follow-up. Of 688 eligible patients, 280 patients (73% male and 66% principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n = 143) or clinic-based (n = 137) post-discharge management. This will provide 80% power (two-sided alpha of 0.05) to detect a 15% absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63%), coronary artery disease (55%), and atrial fibrillation (53%) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients.

Anabolic Status and Functional Impairment in Men With Mild Chronic Heart Failure

The purpose of this study was to establish the role of hormonal anabolic deficiencies in exercise intolerance in patients with chronic heart failure One hundred four consecutive men (mean age 53.1 ± 10.6 years) with established diagnoses of chronic heart failure were included. At enrollment, blood samples were taken, and echocardiography and cardiopulmonary exercise testing were carried out. Exercise capacity was expressed as peak oxygen consumption (Vo₂), predicted peak Vo₂, and the ventilatory response to exercise (VE/Vco₂) slope. The mean left ventricular ejection fraction was 29.7 ± 11.9%, and most patients (86%) were in New York Heart Association class I or II, with a mean peak Vo₂ of 18 ml/min/kg. According to the age-adjusted reference values, hormonal deficiencies were present in 29% for total testosterone, 39% for estimated free testosterone, 34% for insulin-like growth factor-1, and 61% for dehydroepiandrosterone sulfate. Dehydroepiandrosterone sulfate showed a significant correlation with peak Vo₂ (r = 0.29, p = 0.007), predicted peak Vo₂ (r = 0.28, p = 0.006), and VE/Vco₂ slope (r = -0.39, p <0.001), whereas total testosterone, estimated free testosterone, and insulin-like growth factor-1 were not significantly correlated. After adjusting in a multivariable model, dehydroepiandrosterone sulfate remained an independent predictor of each exercise parameter. In conclusion, in a cohort of patients with mild chronic heart failure, exercise capacity objectively measured using cardiopulmonary exercise testing was related to anabolic impairment of the adrenal rather than the somatotropic or peripheral axis.

Stepwise increase of angiopoietin-2 serum levels is related to haemodynamic and functional impairment in stable chronic heart failure

A reciprocal link between inflammation, oxidative/nitrosative stress, and endothelial dysfunction has been postulated in chronic heart failure (CHF). The endothelial repair mechanisms involved remain to be determined. Our aim was to investigate whether there are detectable signs of ongoing angiogenesis in serum of CHF patients and to evaluate the correlation with indexes of haemodynamic and functional impairment. Enzyme-linked immunosorbent assay tests were used to quantify angiogenin, angiopoietin-1, angiopoietin-2, vascular endothelial growth factor, Tie-2, and brain natriuretic peptide in serum of 87 patients with CHF of increasing severity according to New York Heart Association (NYHA; class I, n = 8; II, n = 45; and III, n = 34) and in 14 healthy subjects matched for age and sex. Angiogenin, angiopoietin-2, and Tie-2 were significantly increased in CHF of increasing severity (Kruskal-Wallis: p = 0.0004, p < 0.0001, and p = 0.017, respectively). Angiopoietin-2 was inversely correlated with the 6-min walking test (r = -0.65, p < 0.0001), peak oxygen consumption (VO(2max); r = -0.57, p = 0.0002), and deceleration time (r = -0.61, p < 0.0001). Multiple regression analysis showed that angiopoietin-2 was mainly associated with VO(2max) (p = 0.018). The angiopoietin-2 area under the receiver operating characteristic curve for CHF diagnosis was 0.94 (95% CI 0.88-0.99; p < 0.001). These data demonstrate that angiopoietin-2 and selected serum markers of angiogenesis progressively increase with haemodynamic and functional decline in CHF.

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Discrimination power of long-term heart rate variability measures for chronic heart failure detection

The aim of this study was to investigate the discrimination power of standard long-term heart rate variability (HRV) measures for the diagnosis of chronic heart failure (CHF). The authors performed a retrospective analysis on four public Holter databases, analyzing the data of 72 normal subjects and 44 patients suffering from CHF. To assess the discrimination power of HRV measures, an exhaustive search of all possible combinations of HRV measures was adopted and classifiers based on Classification and Regression Tree (CART) method was developed, which is a non-parametric statistical technique. It was found that the best combination of features is: Total spectral power of all NN intervals up to 0.4 Hz (TOTPWR), square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) and standard deviation of the averages of NN intervals in all 5-min segments of a 24-h recording (SDANN). The classifiers based on this combination achieved a specificity rate and a sensitivity rate of 100.00 and 89.74%, respectively. The results are comparable with other similar studies, but the method used is particularly valuable because it provides an easy to understand description of classification procedures, in terms of intelligible "if … then …" rules. Finally, the rules obtained by CART are consistent with previous clinical studies.

103 Prevalence, determinant and prognostic value of TAPSE in an outpatient CHF clinic

Few reports exist of the prognostic significance of right ventricle function (RV) variables in chronic heart failure (CHF) and the broad range of left ventricle (LV) ejection encountered in clinical practice. To determine the prevalence, predictors, and prognostic value of RV function measured by the tricuspid annular plane systolic excursion (TAPSE) in patients with symptoms suggesting CHF. Analysis of referrals for diagnosis and management of CHF to a specialist clinic serving a local community. Of 1547 patients studied, mean (SD) age was 71 ± 11 years, 48% were women, mean LV ejection fraction (LVEF) was 47 ± 16% and median (IQR) TAPSE was 18.5 mm (14.0–22.7). LVEF was >45% in 47% and 67% were classified as heart failure. During a median (IQR) follow-up of 63 (41–75) months, overall mortality was 34%. In multivariable analysis, increasing age, NT-proBNP, NYHA class, atrial fibrillation, right atria volume, systolic pulmonary artery pressure (sPAP), lower TAPSE, lower diastolic blood pressure (DBP), lower haemoglobin, diagnosis of COPD, and digoxin and betablocker treatments were all associated with an adverse prognosis but not HF class. A receiver operator curve analysis investigating the relationship between TAPSE and prognosis showed an area under the curve of 0.69 (95%CI (0.64–0.74); p = 0.0001), with a value of 15.9 mm of TAPSE best able to predict outcome. TAPSE<15.9 mm was most strongly associated when NTproBNP was not included in the model with raised in sPAP, DBP, heart rate and with decreased of BMI, eGFR and systolic BP, and presence of atrial fibrillation, ischaemic heart disease and with the severity of mitral regurgitation and S-HF. In patients with symptoms of chronic heart failure, TAPSE, but not variables related to LV systolic function, was an independent predictor of outcome. This simple measure could be used to stratify patient risk in routine clinical practice.

Evidence-based chronic heart-failure management programmes: reality or myth?

BackgroundChronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF).ObjectiveTo investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient...

Diagnostic accuracy of plasma NT-proBNP levels for excluding cardiac abnormalities in the very elderly

BackgroundIn the elderly the diagnosis of chronic heart failure is often challenging and the availability of echocardiography can be limited. Plasma levels of NT-proBNP are valuable tools to diagnose patients with heart failure. However, the performance of this biomarker to detect cardiac abnormalities in the very elderly remains unclear. The aims of this study were to investigate the relation between NT-proBNP and cardiac abnormalities and to evaluate the use of NT-proBNP to exclude structural and functional cardiac abnormalities in a community-based sample of "well-functioning" nonagenarians.MethodsA diagnostic cross-sectional study embedded within the Leiden 85-plus Study in the municipality of Leiden, the Netherlands. Plasma NT-proBNP levels were measured and 2-dimensional echocardiography was performed in a subgroup of 80 well-functioning nonagenarians. Linear regression analysis was used to explore the relation between NT-proBNP and cardiac abnormalities and ROC curve analysis was used to assess the performance of NT-proBNP to exclude cardiac abnormalities. The upper limit of the lowest tertile of NT-proBNP was used as a cut-off value.ResultsNT-proBNP levels were associated with abnormal left ventricular (LV) dimensions, LV systolic and diastolic function, left atrial enlargement and valvular heart disease. LV mass, E/A ratio and degree of aortic regurgitation were identified as independent predictors of NT-proBNP. NT-proBNP levels were higher with greater number of echocardiographic abnormalities (P < 0.001). A cut-off level of 269.5 pg/mL identified patients with abnormal LV dimensions or depressed LV systolic function (sensitivity 85%, negative predictive value (NPV) 77%, area under the curve 0.75 (95% CI 0.64-0.85)). In addition, high NPV were found for LV systolic dysfunction, left atrial enlargement, severe valvular heart disease and pulmonary hypertension. The test performance of NT-proBNP to exclude any echocardiographic abnormality showed a sensitivity of 82% and a NPV of 65%.ConclusionsIn this convenience sample of well-functioning nonagenarians NT-proBNP was related to a wide variety of functional and structural echocardiographic abnormalities. Moreover, NT-proBNP could be used to exclude echocardiographic abnormalities in well-functioning nonagenarians and might be used to indicate who needs to be referred for further cardiovascular examination.