Measuring brain natriuretic peptide in suspected left ventricular systolic dysfunction in general practice: cross-sectional study

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Abstract
The prevalence of heart failure is increasing.1 Patients usually present to their general practitioner but a definitive diagnosis of left ventricular systolic dysfunction can only be achieved by cardiac imaging. Measuring plasma concentrations of brain natriuretic peptide has been advocated as a screening test that might reduce demands on cardiological services.2 We report the results of a community based study designed to investigate the effectiveness of measuring brain natriuretic peptide to diagnose left ventricular systolic dysfunction. The study was approved by the local research ethics committee. General practitioners were invited to refer patients with suspected heart failure to our clinic. The results of transthoracic echocardiography were reported by a single, experienced observer (IA). Ischaemia was diagnosed if Q waves, bundle branch block, T wave inversions, or left ventricular hypertrophy were present on an electrocardiogram. Evidence of heart failure on a chest radiograph was defined as the presence of pulmonary oedema or cardiomegaly. Concentrations of brain natriuretic peptide …