B-type Natriuretic Peptide for Diagnosis of Heart Failure in Emergency Department Patients: A Critical Appraisal

Correlation Between Impedance Cardiography and B-Type Natriuretic Peptide Levels in Dyspneic Patients

“…Although much existing literature suggests that both modalities offer similar diagnostic conclusions, no studies that we are aware of directly compare the results from BNP testing to ICG parameters. Furthermore, studies are increasingly questioning the accuracy of BNP testing, finding in some cases that additional factors such as body mass index, presenting complaints, and associated comorbidities significantly affect accuracy (3,18,19).…”

“…Although the utility of obtaining BNP levels is still debated, BNP levels are used extensively in many hospitals for diagnostic purposes as well as to obtain prognostic information and to guide further therapy (2,3). ICG measurements are often used for similar purposes (9,10).…”

“…Two methods used to diagnose heart failure are serum measurements of B-type natriuretic peptide (BNP) and impedance cardiography (ICG) in which measurements of thoracic electrical impedance are used to estimate various hemodynamic parameters (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Because the time to obtain ICG data is typically much shorter than the time to obtain serum BNP levels, utilization of ICG may provide an advantage in the Emergency Department (ED) if concordant information is obtained (8).…”

Brain natriuretic peptide (BNP) testing in the emergency department

“…In the Logeart study, sensitivity declined from 96% to 71% in patients presenting with less than 4 h duration of symptoms (23). In Japan, a study with rat ventricular cardiocytes looked at gene expression of BNP and found maximal activity at 1 h (8).…”

“…In another critical analysis by Schwam, interval likelihood ratios were calculated from published available data (23) (Table 3 summarizes likelihood ratios from multiple sources). The author suggested that through the use of clinical data (history, physical examination, EKG, and chest radiograph) physicians are able to accurately categorize patients with either a very low (0%-4%) or high (95%-100%) pre-test probability of CHF.…”