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Aims: Assessment of N- terminal brain natriuretic peptide(NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT- BNP. Analysis was performed on 261 patients(132 DDD, 121 VVI, eight others), mean age 73± 12 years, range 34- 99 years. Seventy two subjects(27% ) had heart failure as defined by left ventricular ejection fraction(LVEF) ≤ 40% and symptoms of heart failure(NYHA class II, III, or IV). Screening with NT- BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients [area under the curve(AUC) 0.76, P< 0.001, 95% CI 0.69- 0.83]. This increased in subjects with a DDD type pacemaker(sensitivity 80% , specificity 66% , AUC=0.8, CI 0.7- 0.90) and reduced in subjects with a VVI type pacemaker(sensitivity 66% , specificity 61% , AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT- BNP is feasible and assists in the detection of important cardiac co- morbidity, particularly in patients with a DDD type pacemaker.
Aims: Assessment of N-terminal brain natriuretic peptide (NTBNP) as a screening tool for heart failure in patients with a permanent pacemaker. Methods and results: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiography and blood sampling for NT-BNP. Analysis was performed on 261 patients (132 DDD, 121 VVI, eight others), mean age 73 ± 12 years, range 34-99 years. Seventy two subjects (27%) had heart failure as defined by left ventricular ejection fraction (LVEF) ≤ 40% and symptoms of heart failure (NYHA class II, III, or IV). Screening with NT-BNP gave a sensitivity of 73% and specificity of 72% for detecting heart failure in all patients This increased in subjects with a DDD type pacemaker (sensitivity 80%, specificity 66%, AUC = 0.8, CI 0.7-0.90) and reduced in subjects with a VVI type pacemaker (sensitivity 66%, sp ecificity 61%, AUC 0.68 CI 0.57- 0.78). Conclusion: Symptoms of heart failure are common in patients with pacemakers. Screening with NT-BNP is feasible and assists in the detection of important cardiac co-morbidity, particularly in patients with a DDD type pacemaker.