Value of Adding Natriuretic Peptides and Electrocardiographic Findings to Assess the Presence of Cardiac Dysfunction in Patients ≥80 Years of Age
Studies estimating the added value of natriuretic peptide levels and electrocardiographic findings beyond all relevant clinical information to identify cardiac dysfunction remain scarce. The aim of this study was to assess the presence of clinically relevant cardiac dysfunction in an unselected popu...
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| Veröffentlicht in: | The American journal of cardiology 2013-04, Vol.111 (8), p.1198-1208 |
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| creator | Vaes, Bert, PhD Boland, Benoit, PhD Scavée, Christophe, PhD Henrard, Séverine, MSc Wallemacq, Pierre, PhD Van Pottelbergh, Gijs, MD Matheï, Catharina, PhD Pasquet, Agnes, PhD Vanoverschelde, Jean-Louis, PhD Rezzoug, Nawel, MD Speybroeck, Niko, PhD Degryse, Jan, PhD |
| description | Studies estimating the added value of natriuretic peptide levels and electrocardiographic findings beyond all relevant clinical information to identify cardiac dysfunction remain scarce. The aim of this study was to assess the presence of clinically relevant cardiac dysfunction in an unselected population of subjects aged ≥80 years. A cross-sectional analysis using an “intention-to-diagnose” strategy was performed within the BELFRAIL study (n = 567). Baseline B-type natriuretic peptide and N-terminal pro–B-type natriuretic peptide levels were determined and echocardiography was performed at subjects’ homes. Logistic regression analysis and classification and regression tree analysis were used as complementary analytic tools. Cardiac dysfunction was present in 17% of subjects without and 31% of subjects with chronic atrial fibrillation (AF) or pacemaker. In subjects without chronic AF or pacemaker, the clinical model showed a C-statistic of 0.79 (95% confidence interval 0.74 to 0.85). The combination of natriuretic peptides with normal results on electrocardiography increased, only marginally, the C-statistic. In subjects with chronic AF or pacemaker, the clinical model showed a very high C-statistic of 0.90 (95% confidence interval 0.82 to 0.98). Classification and regression tree analysis showed that an additional 58 subjects (13%) were correctly classified using natriuretic peptides and electrocardiographic findings among those without chronic AF or pacemaker. Of participants with chronic AF or pacemaker, >90% were correctly classified. In conclusion, in a large population-based sample of patients aged ≥80 years, the clinical model possessed high accuracy to identify cardiac dysfunction in daily practice. Among subjects without chronic AF or pacemaker, a larger number were correctly classified by integrating natriuretic peptides and electrocardiographic findings in the strategy. |
| doi_str_mv | 10.1016/j.amjcard.2012.12.055 |
| format | Article |
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The aim of this study was to assess the presence of clinically relevant cardiac dysfunction in an unselected population of subjects aged ≥80 years. A cross-sectional analysis using an “intention-to-diagnose” strategy was performed within the BELFRAIL study (n = 567). Baseline B-type natriuretic peptide and N-terminal pro–B-type natriuretic peptide levels were determined and echocardiography was performed at subjects’ homes. Logistic regression analysis and classification and regression tree analysis were used as complementary analytic tools. Cardiac dysfunction was present in 17% of subjects without and 31% of subjects with chronic atrial fibrillation (AF) or pacemaker. In subjects without chronic AF or pacemaker, the clinical model showed a C-statistic of 0.79 (95% confidence interval 0.74 to 0.85). The combination of natriuretic peptides with normal results on electrocardiography increased, only marginally, the C-statistic. In subjects with chronic AF or pacemaker, the clinical model showed a very high C-statistic of 0.90 (95% confidence interval 0.82 to 0.98). Classification and regression tree analysis showed that an additional 58 subjects (13%) were correctly classified using natriuretic peptides and electrocardiographic findings among those without chronic AF or pacemaker. Of participants with chronic AF or pacemaker, >90% were correctly classified. In conclusion, in a large population-based sample of patients aged ≥80 years, the clinical model possessed high accuracy to identify cardiac dysfunction in daily practice. Among subjects without chronic AF or pacemaker, a larger number were correctly classified by integrating natriuretic peptides and electrocardiographic findings in the strategy.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2012.12.055</identifier><identifier>PMID: 23375597</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged, 80 and over ; Atrial Fibrillation - blood ; Atrial Fibrillation - complications ; Biomarkers - blood ; C-Reactive Protein - metabolism ; Cardiology ; Cardiovascular ; Cardiovascular disease ; Cardiovascular Diseases - diagnosis ; Comorbidity ; Cross-Sectional Studies ; Echocardiography ; Electrocardiography ; Female ; Heart attacks ; Humans ; Logistic Models ; Male ; Natriuretic Peptide, Brain - blood ; Pacemaker, Artificial ; Peptide Fragments - blood ; Peptides ; Prospective Studies ; Statistics, Nonparametric</subject><ispartof>The American journal of cardiology, 2013-04, Vol.111 (8), p.1198-1208</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 15, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-aaf97b57663141cf86ccf3095338a6db5b7f07d2455a0554637c8bed159662203</citedby><cites>FETCH-LOGICAL-c448t-aaf97b57663141cf86ccf3095338a6db5b7f07d2455a0554637c8bed159662203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1327916269?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23375597$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vaes, Bert, PhD</creatorcontrib><creatorcontrib>Boland, Benoit, PhD</creatorcontrib><creatorcontrib>Scavée, Christophe, PhD</creatorcontrib><creatorcontrib>Henrard, Séverine, MSc</creatorcontrib><creatorcontrib>Wallemacq, Pierre, PhD</creatorcontrib><creatorcontrib>Van Pottelbergh, Gijs, MD</creatorcontrib><creatorcontrib>Matheï, Catharina, PhD</creatorcontrib><creatorcontrib>Pasquet, Agnes, PhD</creatorcontrib><creatorcontrib>Vanoverschelde, Jean-Louis, PhD</creatorcontrib><creatorcontrib>Rezzoug, Nawel, MD</creatorcontrib><creatorcontrib>Speybroeck, Niko, PhD</creatorcontrib><creatorcontrib>Degryse, Jan, PhD</creatorcontrib><title>Value of Adding Natriuretic Peptides and Electrocardiographic Findings to Assess the Presence of Cardiac Dysfunction in Patients ≥80 Years of Age</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Studies estimating the added value of natriuretic peptide levels and electrocardiographic findings beyond all relevant clinical information to identify cardiac dysfunction remain scarce. The aim of this study was to assess the presence of clinically relevant cardiac dysfunction in an unselected population of subjects aged ≥80 years. A cross-sectional analysis using an “intention-to-diagnose” strategy was performed within the BELFRAIL study (n = 567). Baseline B-type natriuretic peptide and N-terminal pro–B-type natriuretic peptide levels were determined and echocardiography was performed at subjects’ homes. Logistic regression analysis and classification and regression tree analysis were used as complementary analytic tools. Cardiac dysfunction was present in 17% of subjects without and 31% of subjects with chronic atrial fibrillation (AF) or pacemaker. In subjects without chronic AF or pacemaker, the clinical model showed a C-statistic of 0.79 (95% confidence interval 0.74 to 0.85). The combination of natriuretic peptides with normal results on electrocardiography increased, only marginally, the C-statistic. In subjects with chronic AF or pacemaker, the clinical model showed a very high C-statistic of 0.90 (95% confidence interval 0.82 to 0.98). Classification and regression tree analysis showed that an additional 58 subjects (13%) were correctly classified using natriuretic peptides and electrocardiographic findings among those without chronic AF or pacemaker. Of participants with chronic AF or pacemaker, >90% were correctly classified. In conclusion, in a large population-based sample of patients aged ≥80 years, the clinical model possessed high accuracy to identify cardiac dysfunction in daily practice. Among subjects without chronic AF or pacemaker, a larger number were correctly classified by integrating natriuretic peptides and electrocardiographic findings in the strategy.</description><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation - blood</subject><subject>Atrial Fibrillation - complications</subject><subject>Biomarkers - blood</subject><subject>C-Reactive Protein - metabolism</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Comorbidity</subject><subject>Cross-Sectional Studies</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Pacemaker, Artificial</subject><subject>Peptide Fragments - blood</subject><subject>Peptides</subject><subject>Prospective Studies</subject><subject>Statistics, Nonparametric</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFks2KFDEQx4Mo7rj6CErAi5ce89FJdy7KMO6qsOiAH-AppJPq2Yw96dmkW5hH2PM-gy_mk5jeGRX2IhQkgd-_qlL_QugpJXNKqHy5mZvtxpro5oxQNs9BhLiHZrSuVEEV5ffRjBDCCkVLdYIepbTJT0qFfIhOGOeVEKqaoZuvphsB9y1eOOfDGn8wQ_RjhMFbvILd4B0kbILDZx3YIfZTSd-vo9ldZuLch0mV8NDjRUqQ8u0S8CpCgmBv8y4ngbH4zT61Y7CD7wP2Aa_M4CEMCf-6_lkT_A1MTLdtrOExetCaLsGT43mKvpyffV6-Ky4-vn2_XFwUtizroTCmVVUjKik5Lalta2lty4kSnNdGukY0VUsqx0ohTJ5NKXll6wYcFUpKxgg_RS8OeXexvxohDXrrk4WuMwH6MWnKWclrVRKR0ed30E0_xpC7m6hKUcmkypQ4UDb2KUVo9S76rYl7TYmeXNMbfXRNT67pHLmzrHt2zD42W3B_VX9sysDrAwB5HD88RJ2snwbsfMyuaNf7_5Z4dSeD7Xzw1nTfYQ_p3290ygL9aVqdaXMoI0yKWvLfcGfAYw</recordid><startdate>20130415</startdate><enddate>20130415</enddate><creator>Vaes, Bert, PhD</creator><creator>Boland, Benoit, PhD</creator><creator>Scavée, Christophe, PhD</creator><creator>Henrard, Séverine, MSc</creator><creator>Wallemacq, Pierre, PhD</creator><creator>Van Pottelbergh, Gijs, MD</creator><creator>Matheï, Catharina, PhD</creator><creator>Pasquet, Agnes, PhD</creator><creator>Vanoverschelde, Jean-Louis, PhD</creator><creator>Rezzoug, Nawel, MD</creator><creator>Speybroeck, Niko, PhD</creator><creator>Degryse, Jan, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130415</creationdate><title>Value of Adding Natriuretic Peptides and Electrocardiographic Findings to Assess the Presence of Cardiac Dysfunction in Patients ≥80 Years of Age</title><author>Vaes, Bert, PhD ; Boland, Benoit, PhD ; Scavée, Christophe, PhD ; Henrard, Séverine, MSc ; Wallemacq, Pierre, PhD ; Van Pottelbergh, Gijs, MD ; Matheï, Catharina, PhD ; Pasquet, Agnes, PhD ; Vanoverschelde, Jean-Louis, PhD ; Rezzoug, Nawel, MD ; Speybroeck, Niko, PhD ; Degryse, Jan, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-aaf97b57663141cf86ccf3095338a6db5b7f07d2455a0554637c8bed159662203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation - blood</topic><topic>Atrial Fibrillation - complications</topic><topic>Biomarkers - blood</topic><topic>C-Reactive Protein - metabolism</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Comorbidity</topic><topic>Cross-Sectional Studies</topic><topic>Echocardiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Pacemaker, Artificial</topic><topic>Peptide Fragments - blood</topic><topic>Peptides</topic><topic>Prospective Studies</topic><topic>Statistics, Nonparametric</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vaes, Bert, PhD</creatorcontrib><creatorcontrib>Boland, Benoit, PhD</creatorcontrib><creatorcontrib>Scavée, Christophe, PhD</creatorcontrib><creatorcontrib>Henrard, Séverine, MSc</creatorcontrib><creatorcontrib>Wallemacq, Pierre, PhD</creatorcontrib><creatorcontrib>Van Pottelbergh, Gijs, MD</creatorcontrib><creatorcontrib>Matheï, Catharina, PhD</creatorcontrib><creatorcontrib>Pasquet, Agnes, PhD</creatorcontrib><creatorcontrib>Vanoverschelde, Jean-Louis, PhD</creatorcontrib><creatorcontrib>Rezzoug, Nawel, MD</creatorcontrib><creatorcontrib>Speybroeck, Niko, PhD</creatorcontrib><creatorcontrib>Degryse, Jan, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vaes, Bert, PhD</au><au>Boland, Benoit, PhD</au><au>Scavée, Christophe, PhD</au><au>Henrard, Séverine, MSc</au><au>Wallemacq, Pierre, PhD</au><au>Van Pottelbergh, Gijs, MD</au><au>Matheï, Catharina, PhD</au><au>Pasquet, Agnes, PhD</au><au>Vanoverschelde, Jean-Louis, PhD</au><au>Rezzoug, Nawel, MD</au><au>Speybroeck, Niko, PhD</au><au>Degryse, Jan, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Value of Adding Natriuretic Peptides and Electrocardiographic Findings to Assess the Presence of Cardiac Dysfunction in Patients ≥80 Years of Age</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2013-04-15</date><risdate>2013</risdate><volume>111</volume><issue>8</issue><spage>1198</spage><epage>1208</epage><pages>1198-1208</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Studies estimating the added value of natriuretic peptide levels and electrocardiographic findings beyond all relevant clinical information to identify cardiac dysfunction remain scarce. The aim of this study was to assess the presence of clinically relevant cardiac dysfunction in an unselected population of subjects aged ≥80 years. A cross-sectional analysis using an “intention-to-diagnose” strategy was performed within the BELFRAIL study (n = 567). Baseline B-type natriuretic peptide and N-terminal pro–B-type natriuretic peptide levels were determined and echocardiography was performed at subjects’ homes. Logistic regression analysis and classification and regression tree analysis were used as complementary analytic tools. Cardiac dysfunction was present in 17% of subjects without and 31% of subjects with chronic atrial fibrillation (AF) or pacemaker. In subjects without chronic AF or pacemaker, the clinical model showed a C-statistic of 0.79 (95% confidence interval 0.74 to 0.85). The combination of natriuretic peptides with normal results on electrocardiography increased, only marginally, the C-statistic. In subjects with chronic AF or pacemaker, the clinical model showed a very high C-statistic of 0.90 (95% confidence interval 0.82 to 0.98). Classification and regression tree analysis showed that an additional 58 subjects (13%) were correctly classified using natriuretic peptides and electrocardiographic findings among those without chronic AF or pacemaker. Of participants with chronic AF or pacemaker, >90% were correctly classified. In conclusion, in a large population-based sample of patients aged ≥80 years, the clinical model possessed high accuracy to identify cardiac dysfunction in daily practice. Among subjects without chronic AF or pacemaker, a larger number were correctly classified by integrating natriuretic peptides and electrocardiographic findings in the strategy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23375597</pmid><doi>10.1016/j.amjcard.2012.12.055</doi><tpages>11</tpages></addata></record> |
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| ispartof | The American journal of cardiology, 2013-04, Vol.111 (8), p.1198-1208 |
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| subjects | Aged, 80 and over Atrial Fibrillation - blood Atrial Fibrillation - complications Biomarkers - blood C-Reactive Protein - metabolism Cardiology Cardiovascular Cardiovascular disease Cardiovascular Diseases - diagnosis Comorbidity Cross-Sectional Studies Echocardiography Electrocardiography Female Heart attacks Humans Logistic Models Male Natriuretic Peptide, Brain - blood Pacemaker, Artificial Peptide Fragments - blood Peptides Prospective Studies Statistics, Nonparametric |
| title | Value of Adding Natriuretic Peptides and Electrocardiographic Findings to Assess the Presence of Cardiac Dysfunction in Patients ≥80 Years of Age |
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