Clinical criteria and biochemical markers for the detection of systolic dysfunction

Background: This study was designed to assess the use of clinical criteria and biochemical testing to detect systolic dysfunction. Our goal is to develop strategies that may enhance the detection and treatment of patients with early ventricular dysfunction while reducing the use of echocardiography. Methods and Results: We compared the predictive characteristics of the plasma brain natriuretic peptide (BNP) concentration with that of a 5-point clinical score derived from elements of the history, electrocardiogram, and chest radiograph in outpatients (n = 466) referred for echocardiography because of symptoms of heart failure or risk factors for systolic dysfunction. Systolic dysfunction was defined as an ejection fraction (EF) less than 45% and was present in 10.9% of patients. By receiver operating characteristic analysis, BNP was sensitive and specific for the detection of systolic dysfunction, with an area under the receiver operating characteristic curve for the detection of EF less than 45% of 0.79. The BNP assay was abnormal in 41% of patients and identified a group with a high prevalence of systolic dysfunction (21% with an EF less than 45%), whereas a normal BNP value identified a group with a low prevalence of systolic dysfunction (4% with an EF less than 45%). The clinical score was positive in 43% of the population and identified a group with a high prevalence of systolic dysfunction (24% with an EF less than 45%). A normal score identified a group with a low prevalence of systolic dysfunction (1% with an EF less than 45%). Conclusion: This study supports previous studies, which showed that BNP assay predicts systolic dysfunction with acceptable sensitivity and specificity, and it underscores the effectiveness of additional readily available clinical criteria. Both of these strategies should be considered in screening for left ventricular dysfunction in populations at risk while limiting expensive cardiac imaging modalities.