Biochemical detection of left-ventricular systolic dysfunction

Lancet. 1998 Jan 3;351(9095):9-13. doi: 10.1016/s0140-6736(97)03034-1.


Background: In previous studies on the use of natriuretic peptides to detect left-ventricular systolic dysfunction, a higher rate of cardiac disorders in the control groups than in the study groups could have led to bias. We investigated the effectiveness of plasma N-terminal atrial natriuretic peptide (NT-ANP) and brain natriuretic peptide (BNP) concentrations to show left-ventricular systolic dysfunction in a random sample of the general population.

Methods: We randomly selected 2000 participants aged 25-74 years from family physicians' lists in Glasgow, UK. We sent all participants questionnaires. 1653 respondents underwent echocardiography and electrocardiography. We took a left-ventricular ejection fraction of 30% or less to show left-ventricular systolic dysfunction. NT-ANP and BNP were measured in plasma by RIAs.

Findings: 1252 participants had analysable electrocardiograms and echocardiograms, completed questionnaires, and available blood samples. Median concentrations of NT-ANP and BNP were significantly higher in participants with left-ventricular systolic dysfunction (2.8 ng/mL [IQR 1.8-4.6] and 24.0 pg/mL [18.0-33.0]) than in those without (1.3 ng/mL [0.9-1.8] and 7.7 pg/mL [3.4-13.0]; each p < 0.001). Among participants with left-ventricular systolic dysfunction, both symptomatic and asymptomatic subgroups had raised NT-ANP and BNP concentrations. A BNP concentration of 17.9 pg/mL or more gave a sensitivity of 77% and specificity of 87% in all participants, and 92% and 72% in participants aged 55 years or older.

Interpretation: Measurement of BNP could be a cost-effective method of screening for left-ventricular systolic dysfunction in the general population, especially if its use were targeted to individuals at high risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Atrial Natriuretic Factor / blood*
  • Biomarkers / blood
  • Echocardiography
  • Electrocardiography
  • Female
  • Heart Failure / blood
  • Heart Failure / diagnosis*
  • Heart Failure / prevention & control
  • Humans
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Natriuresis
  • Natriuretic Peptide, Brain
  • Nerve Tissue Proteins / blood*
  • Predictive Value of Tests
  • ROC Curve
  • Random Allocation
  • Scotland / epidemiology
  • Sensitivity and Specificity
  • Ventricular Dysfunction, Left / blood
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / prevention & control


  • Biomarkers
  • Nerve Tissue Proteins
  • Natriuretic Peptide, Brain
  • Atrial Natriuretic Factor