B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

Abstract

Background-It is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnea to the emergency department (ED). This study assessed whether B-type natriuretic peptide (BNP) testing in these patients improved the accuracy of HF diagnosis. Methods and Results-Patients presenting to the Alfred and the Northern Hospital EDs with a chief complaint of dyspnea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic gold standard for HF was determined by 1 cardiologist and 1 emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non-BNP group showed a sensitivity, specificity, and accuracy of 65%, 92%, and 81%, respectively. The BNP group had a similar sensitivity, specificity, and accuracy of 66%, 90%, and 78%, respectively, for the diagnosis of HF in the ED. There was no significant difference between the BNP and non-BNP groups in any of the measures of diagnostic accuracy for HF. Conclusion-In the clinical setting of EDs, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF.

Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting

“…In addition, it was reported that BNP does not reliably distinguish ARDS from AHFS [44]. In our study, the BNP level of patients with a history of heart failure who had dyspnea due to pulmonary disease or ARDS showed no significant difference compared to that of patients with acute dyspnea due to AHFS, a finding that is in agreement with prior reports [42,43]. Therefore, among patients with acute dyspnea (including those with a history of heart failure and those with ARDS), the baseline BNP level alone could have various limitations for making a differential diagnosis in the emergency setting, and further research is needed to address this issue.…”

“…Recently, BNP and N-terminal pro-BNP have been studied extensively and are frequently used in clinical practice. However, some recent randomized trials on the use of BNP to aid in diagnosis or serial BNP levels to dictate therapy in the acute setting found no improvement of diagnostic accuracy or important clinical outcomes because age, sex, and renal dysfunction have an impact on natriuretic peptide levels and need to be considered when test results are interpreted [42,43]. Also, patients with a history of decompensated HF can have chronically elevated BNP or N-terminal pro-BNP levels, making the test inconclusive.…”

Midregional Pro–Atrial Natriuretic Peptide for the Diagnosis of Cardiac-Related Dyspnea according to Renal Function in the Emergency Department: A Comparison with B-Type Natriuretic Peptide (BNP) and N-Terminal ProBNP

“…Furthermore, we have not been able to provide bibliographical or manufacturer's data regarding the stability of MR-proANP under the storage conditions used: this important factor needs to be tested in future studies. Finally, questions may be raised regarding the degree to which biomarkers can improve clinical judgment in the diagnosis of acute heart failure: indeed, some studies have demonstrated that combining clinical evaluation with natriuretic peptide testing increases the probability of a correct diagnosis of CRD (10,12,13 ), whereas others were not able to show any significant improvement (39 ). However, we believe that an optimum use of natriuretic peptides can be achieved by considering, first, that they only form part of the diagnostic evaluation (15 ) and, second, that their thresholds can be adapted to the patient's characteristics.…”

Comparison of the Diagnostic Characteristics of Two B-Type Natriuretic Peptide Point-of-Care Devices

“…However, prior studies have indicated that the method of determining the clinical diagnosis and therefore its accuracy is fraught with difficulties (14). Furthermore, many of our study patients did not have a formal cardiologic and echocardiographic evaluation that has been used in many previous studies such as the one noted above (12).…”