medigraphic.com
Colegio de Medicina Interna de México.

2005, Number 2

Next >>

Med Int Mex 2005; 21 (2)

Diagnostic utility of clinical criteria for the detection of left ventricular systolic and diastolic dysfunction compared with echocardiography and NT-proBNP levels

Fidel BJ, Castillo ML, Orea TA, Valles SV, González TR, Asensio LE, Rebollar GV, Corzo LD, Dorantes GJ, Narváez DR

Language: Spanish
References: 24
Page: 91-105
PDF size: 67.88 Kb.


ABSTRACT

Background: As left ventricular dysfunction often occurs in the absence of a known cardiovascular disease, this condition may go unrecognized and treated when symptoms already exist and ventricular functions are severely depressed.
Objective: To evaluate several clinical factors as early detectors of ventricular dysfunction.
Patients and methods: We studied 178 patients with a clinical questionnaire that included factors usually associated with ventricular systolic and diastolic dysfunction. Transthoracic echocardiograms as well as a determination of NT-proBNP in each patient were performed.
Results: We identified 27 patients with left systolic and 54 patients with left diastolic ventricular dysfunction. When more than three risk factors were present, there was a 70% of probability of finding a systolic dysfunction (risk factors included: ischemic heart disease, pacemaker, tobacco use, male gender and age older than 70 years). When three or more risk factors were present for diastolic dysfunction (systemic hypertension, snoring and age older than 70 years), there was more than 50% of possibilities of finding it.
Conclusions: Our model suggests that for patients with three or more risk factors an echocardiogram should be performed in order to evaluate the left ventricular function.


REFERENCES

  1. Graves EG, Gillum BS, 1994 Summary: National Hospital Discharge Survey: advanced data. National Centre for Health Statistics 1996;pp:278:1

  2. Ho KK, Anderson KM, Kannel WB. Survival after onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993;88:107.

  3. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. Circulation 2001;104:2996-3007.

  4. McMurray JV, McDonagh TA, Davie AP, Cleland JG, Francis CM, Morrison C. Should we screen for asymptomatic left ventricular dysfunction to prevent heart failure? Eur Heart J 1998;19:842-6.

  5. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implication of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6.

  6. Sheps SG, Frohlich ED. Limited echocardiography for hypertensive left ventricular hypertrophy: Hypertension 1997;29:560-63.

  7. Wang TJ, Levy D, Benjamin EJ, Vasan RS. The epidemiology of “asymptomatic” left ventricular systolic dysfunction: Implication for screening. Ann Intern Med 2003;138:907-16.

  8. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289:194-202.

  9. Marantz PR, Tobin JN, Wassertheil-Smoller S, et al. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 1988;77:607-12.

  10. Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology: Remme WJ, Swedberg K, et al. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22:1527-60.

  11. Davis M, Hobbs F, Davis R, Kenkre J, Roalfe AK, Hare R, et al. Prevalence of left ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England screeening study: a population based study. Lancet 2001;358:439-44.

  12. McDonagh TA, Morrison CE, Lawrence A, Ford I, Tunstall-Pedoe H, McMurray JJ, et al. Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997;350:829-33.

  13. Gottdiener JS, McClelland RL, Marshall R, Shemanski L, Furberg CD, Kitzman DW, et al. Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study. Ann Intern Med 2002;137:631-9.

  14. Devereux RB, Bella JN, Palmieri V, Oberman A, Kitzman DW, Hopkins P, et al. Left ventricular systolic dysfunction in a biracial sample of hypertensive adults: The Hypertension Genetic Epidemiology Network (HyperGEN) Study. Hypertension 2001;38:417-23.

  15. Davidson NC, Naas AA, Hanson JK, Kennedy NS, Coutie WJ, Struthers AD. Comparison of atrial natriuretic peptide, B-type natriuretic peptide, and N-terminal proatrial natriuretic peptide as indicators of left ventricular systolic dysfunction. Am J Cardiol 1996;77:828-31.

  16. Clerico A, Iervasi G, Del Chicca MG, et al. Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure. J Endocrinol Invest 1998;21:170-9.

  17. Harrison A, Morrison LK, Krishnaswamy P, et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med 2002;39:131-8.

  18. Smith H, Pickering RM, Struthers A, Simpson I, Mant D. Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study. BMJ 2000;320:960-8.

  19. Suzuki T, Yamaoki K, Nakajima O, et al. Screening for cardiac dysfunction in asymptomatic patients by measuring B-type natriuretic peptide levels. Jpn Heart J 2000;41:205-14.

  20. Maisel AS, Koon J, Krishnaswamy P, et al. Utility of B-type natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J 2001;141:367-74.

  21. Luchner A, Burnett JC, Jougasaki M, et al. Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hyperthophy in the population. J Hypertens 2000;18:1121-8.

  22. Vasan RS, Benjamin EJ, Larson MG, et al. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction. The Framingham Heart Study. JAMA 2002;288:1252-9.

  23. Maisel AS, Krishnaswamy P, Nowak RM, Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002;347:161-7.

  24. Lubien E, DeMaria A, Krishnaswamy P, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction. Circulation 2002;105:595-601.




2020     |     www.medigraphic.com