Utility of biomarkers in the differential diagnosis of heart failure in older people : findings from the Heart Failure In Care Homes (HFinCH) Diagnostic Accuracy Study
| Autor: | Esther Wood, Douglas W. Wilson, Nehal Hussain, G. Brennan, Helen Close, Ahmet Fuat, A Pali S Hungin, Raj Singh, Mark A. de Belder, Andrew Teggert, David Hodges, Novin Manshani, Nitin Kumar, Helen C. Hancock, James Mason, Jerry J Murphy |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Care homes lcsh:Medicine Diagnostic accuracy Cardiovascular Diagnostic Radiology Ventricular Dysfunction Left Natriuretic Peptide Brain Pathology lcsh:Science Ultrasonography Aged 80 and over Incidental Findings education.field_of_study Multidisciplinary Ejection fraction Stroke volume Home Care Services Echocardiography Cardiology Medicine Female Radiology Research Article Test Evaluation medicine.medical_specialty Population Diagnosis Differential Copeptin Diagnostic Medicine Internal medicine medicine Humans Intensive care medicine education Aged Heart Failure business.industry lcsh:R Stroke Volume medicine.disease Long-Term Care Peptide Fragments United Kingdom ROC Curve Geriatrics Heart failure lcsh:Q Differential diagnosis business Biomarkers General Pathology |
| Zdroj: | PLoS ONE, 2013, Vol.8(1), pp.e53560 [Peer Reviewed Journal] PLoS ONE, Vol 8, Iss 1, p e53560 (2013) PLoS ONE |
| DOI: | 10.1371/journal.pone.0053560 |
| Popis: | Background The performance of biomarkers for heart failure (HF) in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD) and HF with preserved ejection fraction (HFpEF). Methods This is the first diagnostic accuracy study in this population to assess the differential diagnostic performance and acceptability of a range of biomarkers against a clinical diagnosis using portable echocardiography. A total of 405 residents, aged 65–100 years (mean 84.2), in 33 UK long-term care facilities were enrolled between April 2009 and June 2010. Results For undifferentiated HF, BNP or NT-proBNP were adequate rule-out tests but would miss one in three cases (BNP: sensitivity 67%, NPV 86%, cut-off 115 pg/ml; NT-proBNP: sensitivity 62%, NPV 87%, cut-off 760 pg/ml). Using higher test cut-offs, both biomarkers were more adequate tests of LVSD, but would still miss one in four cases (BNP: sensitivity 76%, NPV 97%, cut-off 145 pg/ml; NT-proBNP: sensitivity 73%, NPV 97%, cut-off 1000 pg/ml). At these thresholds one third of subjects would test positive and require an echocardiogram. Applying a stricter ‘rule out’ threshold (sensitivity 90%), only one in 10 cases would be missed, but two thirds of subjects would require further investigation. Biomarkers were less useful for HFpEF (BNP: sensitivity 63%, specificity 61%, cut-off 110 pg/ml; NT-proBNP: sensitivity 68%, specificity 56%, cut-off 477 pg/ml). Novel biomarkers (Copeptin, MR-proADM, and MR-proANP) and common signs and symptoms had little diagnostic utility. Conclusions No test, individually or in combination, adequately balanced case finding and rule-out for heart failure in this population; currently, in-situ echocardiography provides the only adequate diagnostic assessment. Trial Registration Controlled-Trials.com ISRCTN19781227 |
| Databáze: | OpenAIRE |
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