David Brill
The incidence of heart failure could be reduced by adopting routine screening for N terminal pro-B-type natriuretic peptide (NT–proBNP), an international group of experts has advised.
The biomarker offers important information on both diagnosis and prognosis, and "holds great promise" for screening high-risk populations, the panel wrote in a consensus statement published earlier this year.
"We need to shift from a reactive to a proactive mode," the
group’s co-chairman Dr. James Januzzi told Medical Tribune.
"Rather than just waiting for the disease to show itself we’re now shifting our focus upstream in the process to better recognize the earliest changes in the heart prior to this very high-risk situation developing."
Januzzi, who spoke recently on the topic at the 17th ASEAN Congress of Cardiology in Hanoi, Vietnam, said that patients with diabetes, hypertension, left ventricular hypertrophy and men aged over 65 would benefit most from routine screening.
He added that NT-proBNP testing is more cost-effective than echocardiography which, although a useful tool for detecting heart failure, is not widely available and requires extensive training to operate. Chest X-ray and physical examination are neither sensitive nor specific for the condition, he said.
The International Collaborative of NT-proBNP (ICON) study showed that when using age-related cut-off points, NT-proBNP testing was 90 percent sensitive and 84 percent specific for detecting acute heart failure. Using a standard cut-point of 300 pg/mL, the test had a 98 percent negative predictive value for ruling out the condition. [Eur Heart J 2006 Feb;27(3):330-7]
NT-proBNP testing is particularly relevant for primary care doctors, Januzzi said, since the majority of the at-risk population falls into their hands.
"Having an objective means to say that their patient is at high risk and thus, despite their adjustments in medication, should probably be sent to a specialist, is yet another example of where the value of this marker is going to be heading," he said.
NT-proBNP, which is primarily released by the cardiac ventricles in response to the stretching of myocytes, has been studied extensively as a prognostic indicator for patients with established heart failure and acute coronary syndromes but is not yet widely accepted as a diagnostic screening tool.
The consensus statement, which comprises a series of reviews on the different applications for NT-proBNP, was published in The American Journal of Cardiology.
Heart failure is responsible for around 1 million hospital admissions each year in the US alone, and is thought to cost the health-care system there around US$60 billion.
The Massachusetts General Hospital, Boston, US, has already begun implementing NT-proBNP screening said Januzzi, who is director of the cardiac intensive care unit and an associate professor of medicine at Harvard Medical School.
"We need to have a much, much higher level of suspicion for this very common diagnosis, which is only going to get more common as the population ages. Testing for natriuretic peptide – contrary to many other diagnostics that seem to come and go – is here to stay," he said.
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