Heart Failure In Population Over 50 Years In Bulgaria

Abstract

The purpose of this study was to assess the usefulness of measurement of serum natriuretic peptide levels (NT-proBNP) when added to ordinary ECG and echocardiography investigation in patients over 50 years admitted to an ambulatory practice with suspected heart failure (HF) for establishment of the real frequency of HF in this population. Materials and methods: Baseline plasma NT-proBNP concentrations were measured in 512 patients, every second entered to an ambulatory cardiology practice and underwent physician’s examination. Ten study centers participated and study duration was 6 months. Patients with chronic renal insufficiency, аnemia, on hormonal therapy and these with chronic obstructive pulmonary disease (COPD) were excluded from the study. All patients had clinical examination, ECG and echocardiographic evaluation, and gave a blood sample for creatinine and NT-proBNP. The non-invasive investigations were performed without knowledge of NT-proBNP levels. The patients were divided into 7 groups according to the presence or absence of arterial hypertension (AH) or coronary artery disease (CAD) in their history, clinical signs of HF, data for left ventricular hypertrophy (LVH), systolic (LVSD) and diastolic left ventricular dysfunction (LVDD) or both, presence of previous CAD with or without myocardial infarction (MI). Results:
37,1% of study patients had normal BP as measured by the physician, 11,3% – no AH nor CAD and 45 survived previous MI. The mean NT-proBNP level in the study patients was 298 ± 53,42 pg/ml. NT-proBNP <100 pg/ml was measured in 47,5% (n = 243) patients, levels of 101-500 pg/ml – in 33,6% (n = 172) аnd >
500 pg/ml – in 18,9% (n = 97). Patients with diabetes type I had a significant difference in NT-proBNP levels <100 and > 500 pg/ml (p = 0,005). We found that patients with normal LV function on echocardioghraphy (n = 180) had NT-proBNP > 500 pg/ml in 10%, these with LVDD (n = 271) did not have a significant
difference in NT-proBNP levels. Patients with LVSD on echocardiography (n = 61) and BP > 130/80 mmHg showed a significant difference in NT-proBNP levels <100 and > 500 pg/ml (p = 0,0001). Conclusion: Measurement of NT-proBNP levels contributed to other noninvasive clinical investigations in patients over 50
years with or without previously known AH or CAD, even if they are asymptomatic, with or without changes on echocardiography. It had a great contribution to identify patients with initiated heart failure.