Plasma Natriuretic Peptides for Community Screening for Left Ventricular Hypertrophy and Systolic Dysfunction

IT IS WIDELY ACKNOWLEDGED THAT asymptomatic left ventricular systolic dysfunction (LVSD) is a treatable precursor of congestive heart failure. This has generated enthusiasm for developing community-based screening tools for LVSD with the belief that early detection will be clinically beneficial. Similarly, the demonstration of echocardiographic left ventricular (LV) mass as a risk factor for cardiovascular events has spurred interest in screening select populations such as those with hypertension with a “limited” echocardiogram. The notion of community-wide screening for LVSD or left ventricular hypertrophy (LVH), however, has been challenged by concerns over the costs of echocardiography. In this context, the demonstration that patients with LVSD or LVH have elevated plasma natriuretic peptide levels, coupled with the availability of inexpensive assays, has spawned interest that these peptides may serve as useful initial screening tests. Several studies have reported on the use of the brain natriuretic peptide (BNP) and the N-terminal component of proatrial natriuretic peptide (NT-ANP) for detecting asymptomatic LVSD and LVH. Theseprior investigationshave been limited, however, by selection biases, small samples, sex-pooled analyses, inclusion of patients with both symptomatic and asymptomatic LVSD, and the use of less sensitive first-generation