TY - JOUR
T1 - Ability of brain natriuretic peptide tests and homocysteine to exclude congestive heart failure
AU - Barak, Mira
AU - Schliamser, Jorge E.
AU - Yaniv, Nisan
AU - Froom, Paul
PY - 2010
Y1 - 2010
N2 - Among the most promising tests for early detection of congestive heart failure (CHF) are brain natriuretic peptides (BNPs), but it is unclear if homocysteine can aid in differentiating those with and without disease. We attempt to use a combination of tests to reduce the need for echocardiography without missing any cases of CHF. We compared 50 CHF patients with an ejection fraction of less than 60%, to 100 patients with non-specific symptoms but with a normal echocardiogram. After setting sensitivity at 100%, specificities for BNP, amino-terminal probrain natriuretic peptide (NT-pro BNP), and homocysteine were 34%, 28% and 36% respectively. Combinations of two tests if ho-mocysteine was included increased the specificity to 56%. The AUC for BNP and NT-proBNP were not significantly different (92.8 and 95.9, respectively) whereas the AUC for BNP and NT-proBNP tests were superior to homocysteine (83.2). Compared with performing echocardiography in all patients, savings were dependent on the pretest probability. At a 1% pretest probability of CHF, savings were 44.5% while using a combination of NT-proBNP with homocysteine test. Homocysteine can be used in combination with either of the BNPs to decrease costs of early detection of CHF.
AB - Among the most promising tests for early detection of congestive heart failure (CHF) are brain natriuretic peptides (BNPs), but it is unclear if homocysteine can aid in differentiating those with and without disease. We attempt to use a combination of tests to reduce the need for echocardiography without missing any cases of CHF. We compared 50 CHF patients with an ejection fraction of less than 60%, to 100 patients with non-specific symptoms but with a normal echocardiogram. After setting sensitivity at 100%, specificities for BNP, amino-terminal probrain natriuretic peptide (NT-pro BNP), and homocysteine were 34%, 28% and 36% respectively. Combinations of two tests if ho-mocysteine was included increased the specificity to 56%. The AUC for BNP and NT-proBNP were not significantly different (92.8 and 95.9, respectively) whereas the AUC for BNP and NT-proBNP tests were superior to homocysteine (83.2). Compared with performing echocardiography in all patients, savings were dependent on the pretest probability. At a 1% pretest probability of CHF, savings were 44.5% while using a combination of NT-proBNP with homocysteine test. Homocysteine can be used in combination with either of the BNPs to decrease costs of early detection of CHF.
KW - Brain natriuretic peptide
KW - Comparison
KW - Congestive heart failure
KW - Costs
KW - Homocysteine
KW - NT-proBNP
UR - http://www.scopus.com/inward/record.url?scp=77953452348&partnerID=8YFLogxK
U2 - 10.2174/1874241601003010001
DO - 10.2174/1874241601003010001
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
AN - SCOPUS:77953452348
SN - 1874-2416
VL - 3
SP - 1
EP - 4
JO - Open Clinical Chemistry Journal
JF - Open Clinical Chemistry Journal
ER -