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Heart. 2007 November; 93(11): 1397.
PMCID: PMC2016927

Autodiagnosis of systolic dysfunction

Systolic dysfunction could in future be routinely diagnosed with an automated blood test, it has been disclosed, for the first time.

The automated assay for serum N terminal B type natriuretic peptide prohormone (NTproBNP) outperformed an assay for N terminal atrial natriuretic peptide prohormone (NTproANP) in a direct comparison in over 700 randomly selected patients from general practice, with echocardiography and left ventricular ejection fraction as the diagnostic benchmarks for ventricular systolic dysfunction.

It performed significantly better at all values of left ventricular ejection fraction (LVEF) and showed significantly better clinical utility in this group of patients at LVEF[less-than-or-eq, slant]40%—indicating definite left ventricular dysfunction—with areas under the curve in receiver‐operator characteristic curves >0.9 compared with >0.7 for NTproANP.

The assay was performed in parallel with a manual assay for NTproANP on aliquoted blood samples taken from 734 patients with no known ventricular dysfunction from seven general practices in north London. Patients were aged >45 (median 58 (range 45–89)) years and comprised 349 men and 385 women. All were tested between January 2000 and December 2001.

The commercially available NTproBNP assay carries the obvious advantage of large throughput over manual assays for atrial natriuretic peptide and NTproANP currently used to determine ventricular dysfunction in high risk patients, making it potentially suitable for testing in primary care. Whether its performance was comparable, however, was until now unknown; whether it will also outperform the assay for B type natriuretic peptide remains to be seen.

[filled triangle] Galasko G, et al. Journal of Clinical Pathology 2007;60:570–572.

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