PURPOSE: This prospective study investigated the usefulness of proBNP in recognising concomitant left ventricular systolic dysfunction in patients with asthma or COPD.
METHODS: The study group comprised 480 outpatients (250 men, 230 women, mean age 57.3±16.6 years) with asthma (n=356) or COPD (n=124) who underwent a comprehensive diagnostic work-up for cardiac and pulmonary diseases.
RESULTS: Left ventricular function was severely (6), moderately (6) or mildly (8) depressed in 20 patients (4.2%) as evaluated by Doppler echocardiography. ProBNP levels were significantly higher in patients with systolic left ventricular dysfunction than in patients with normal systolic function (median 1194 pg/ml versus 69 pg/ml, p<0.0001). ProBNP cut-off values of 93 pg/ml for men and 144 pg/ml for women excluded left ventricular systolic dysfunction with a negative predictive value of 99.7%. The sensitivity and the specificity were 95.0% and 68.0%, respectively. The positive predictive value was only 11% but many of the 148 patients with elevated proBNP levels and normal systolic left ventricular function had other significant cardiac abnormalities: left ventricular hypertrophy (n=22; 15%), systolic pulmonary artery pressures above 30 mmHg (n=26; 18%), mitral or aortic valvular disease (n=31, 21%). 42 patients (28%) had arterial hypertension, atrial fibrillation or other minor cardiac abnormalities. Only 27 patients (18%) with elevated proBNP had no detectable cardiovascular disease.
CONCLUSION: ProBNP appears to be a perfect test to rule out concomitant left ventricular systolic dysfunction in patients with obstructive lung disease and with a low prevalence of heart failure.
CLINICAL IMPLICATIONS: In the absence of left ventricular systolic dysfunction, elevated proBNP levels were frequently seen in patients with other significant cardiac abnormalities. Therefore, patients with obstructive lung disease and elevated proBNP should be referred for further cardiologic evaluation thus enabling an early identification and treatment of potential precursors of heart failure.
DISCLOSURE: Siegfried Wieshammer, No Financial Disclosure Information; No Product/Research Disclosure Information