Volume 15, Number 3, May-June 2008

The relationship between BNP and risk assessment in cardiac rehabilitation patients
Hugh J N Bethell, Jason D Glover, Julia A Evans, Sally C Turner, Raj L Mehta, Mark A Mullee

Risk stratification is important in the assessment of cardiac patients enrolled in physical training programmes but is often based on inadequate information. Measuring blood B-type natriuretic peptide (BNP) level, a marker of left ventricular dysfunction, might improve risk assessment. In an observational study blood BNP levels were measured in 100 consecutive patients joining a cardiac rehabilitation programme following acute myocardial infarction. The results were compared with the clinical risk assessment – high, moderate or low. There was a significant correlation between risk category (high, moderate or low) and BNP level (r=0.41, p=0.001). A BNP level of 100 pg/L or more gave a sensitivity of 89% (95% confidence interval [CI] 0.69, 0.97) and a specificity of 61% (95% CI 0.57, 0.63) for predicting high-risk patients with a positive predictive value of 33% (95% CI 0.26, 0.36) and a negative predictive value of 96% (95% CI 0.89, 0.99). A BNP level of less than 100 pg/ml gave a sensitivity of 78% (95% CI 0.55, 0.91) and a specificity of 54% (95% CI 0.43, 0.64) for predicting low-risk patients with a positive predictive value of 27% (95% CI 0.17, 0.40) and a negative predictive value of 92% (95% CI 0.80, 0.97). In conclusion, BNP levels provide information that may improve the accuracy of risk assessment of cardiac rehabilitation patients particularly when other information is limited.

Br J Cardiol 2008;15:161-65.

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