[Press and Publications] Breakthrough Hope in Heart Failure Diagnosis [Medical]


Blood test could hold vital clues

Medical experts at the University of Leicester are about to investigate a new blood test technique that could help GPs to diagnose heart failure.

The test may avoid the need for patients to join a hospital waiting list to check for the condition.

Researchers from Department of Medicine and Therapeutics and Department of General Practice and Primary Health Care at the University of Leicester believe the new technique will provide enormous benefits to the patients and the medical profession.

Dr Kamlesh Khunti, a clinical lecturer, said: “Heart failure is a very common condition in which the pumping action of the heart is not working properly. People with heart failure usually feel short of breath and tired, but some people do not have any symptoms. Once people have heart failure their general health can get worse quite quickly.

“There are now drugs that work very well to help people with heart failure to feel better and live longer. However, only about one third of patients who need these drugs actually get them. One of the reasons for this is that it is very difficult for GPs to diagnose heart failure just from a patient’s symptoms and an examination. At the moment patients who are suspected of having heart failure have to have a special investigation called an echocardiogram. This uses ‘ultrasound’ equipment placed on the patient’s chest to get a picture of the heart. This is usually done in hospitals, but there are long waiting lists for echocardiograms.

“Recently there has been an interest in a new blood test that has been developed at a few centres including the University of Leicester. This test could help GPs to diagnose heart failure in their own practice without having to send people to hospital for an echocardiogram. In our study we shall be finding out how well this new test works.”

Volunteers are being asked to take part in the trial through their general practices and the experts are asking people to come forward if they wish to take part.

Dr Khunti said: “A random sample of people over the age of 45 have been selected to be offered the test. This does not mean that they have the disease.

“Tests are being carried out at the Leicester Royal Infirmary. Volunteers are given an echocardiogram and also an electrocardiogram (ECG). Their details are noted and they provide a blood sample and a urine test. Experts at the Leicester Royal Infirmary will be looking at the blood tests, ECGs and echocardiograms to find out whether people have heart failure.

“Volunteers are not asked to take any drugs as part of this research. The volunteer’s GP will get the results and treatment will be advised for people who are found to have heart failure, but this will not be part of the study. The GP will be given the opportunity of sending these patients to the hospital if they feel this is appropriate.

“Any information that is collected will be treated in the strictest confidence. Volunteers are given a study number and their names are not used in any reports or results.”


Medical summary:

The prevalence of systolic heart failure, a common clinical problem in primary care, is set to rise substantially in the next few years. Although effective treatment such as angiotensin converting enzyme inhibitors and beta blockers exist, there is evidence that patients are incorrectly diagnosed and treatment is not directed at the appropriate patients in general practice. This is predominantly a problem of correctly diagnosing such patients. Although echocardiography is a viable option for small scale screening for heart failure, it is not cost effective and is highly operator dependent. A more cost effective screening test for this important health problem is the biochemical detection of cardiac peptides that are elevated in systolic dysfunction. In particular, our preliminary studies have demonstrated that 2 peptides derived from heart are elevated in early stages of systolic left ventricular dysfunction:- (1) the n-terminal of probnp (pro-brain natriuretic peptide) called n-bnp, which is elevated to a greater extent than bnp and is thus easier to measure, and (2) cardiotrophin-1, a novel cytokine that may be responsible for left ventricular dilatation and remodelling, leading to heart failure. Our objective is to assess the sensitivity and specificity of these 2 biochemical markers in the assessment of left ventricular systolic dysfunction, in a general practice population over the age of 45 years. The positive and negative predictive values will be investigated. In addition, we will determine the performance of these 2 markers against bnp-32 itself. This programme of research will establish the effectiveness of these markers in identifying patients in general practice with heart failure (with or without symptoms). This study has been funded by the NHS R&D.

The research team consists of:

Drs Kamlesh Khunti, Leong Ng, Ian Squire, Margaret Stone, and Joan Davies, Department of General Practice and Primary Health Care, and Department of Medicine and Therapeutics, University of Leicester.

For more information, contact Dr Kamlesh Khunti or Margaret Stone on Tel 0116 258 4 873.

Email: kk22@le.ac.uk

Photo opportunities exist by arrangement with Dr Khunti.

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Information supplied by: Barbara Whiteman
Last updated: 16 October 2000 16:41
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