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• W98236452 abstract "Editor—The burden on echocardiography services could indeed be reduced if natriuretic peptide concentrations plus electrocardiography were used as screening tools for left ventricular systolic dysfunction.1 Nielsen et al's paper confirms the high negative predictive value of these tests. Concomitant drug treatment could, however, be a crucial contaminating factor.The use of natriuretic peptides to diagnose left ventricular dysfunction in patients who are already taking cardiac drugs deserves particular attention. Diuretics, digoxin, and angiotensin converting enzyme inhibitors reduce natriuretic peptide concentrations.2 Especially important is the fact that frusemide (furosemide) reduces these concentrations3 but will have virtually no effect on an echocardiogram; it will not alter left ventricular dysfunction. Obviously, therefore, frusemide could severely distort the relation between natriuretic peptides and the echo finding of left ventricular systolic dysfunction.The predictive value of natriuretic peptides could conceivably be considerably affected by the presence of frusemide and other cardiac drugs. This could explain why the sensitivity of natriuretic peptides is low in Nielsen et al's study. No study has yet addressed the usefulness of natriuretic peptides in identifying left ventricular dysfunction before diuretics have been prescribed, which is obviously the real clinical question. When general practitioners want to know if left ventricular dysfunction is the cause of breathlessness in a patient they want to be able to take a blood sample to measure the natriuretic peptide concentration there and then (and before prescribing a diuretic). They can then prescribe a diuretic as a failsafe mechanism pending the result of the test. The opposite may occur with β blockers as recent data suggest that they increase brain natriuretic peptide while having a beneficial effect on left ventricular dilatation.4Cardiac drugs could therefore be a major contaminating factor in the use of natriuretic peptides to diagnose left ventricular dysfunction. An interesting question now arises from Nielsen et al's work: were there any differences in the predictive value of atrial natriuretic peptide concentration, clinical features, findings on electrocardiography, and heart rate and blood pressure between those patients taking cardiac drugs and those patients not taking any treatment in this study?" @default.
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• W98236452 date "2000-07-08" @default.
• W98236452 modified "2023-09-23" @default.
• W98236452 title "Investigations of doctors by General Medical Council. Procedure for consent still leaves much to be desired." @default.
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