Combination of B‐Type Natriuretic Peptide Levels and Non‐Invasive Hemodynamic Parameters in Diagnosing Congestive Heart Failure in the Emergency Department

Abstract

This study aimed to assess whether the combination of a B‐type natriuretic peptide (BNP) level with various noninvasive hemodynamic parameters can help physicians more quickly and accurately diagnose congestive heart failure and determine the type of left ventricular dysfunction present in patients presenting to the emergency department with dyspnea. Subjects were 98 men (aged 64.57±1.23 years) that presented to the VA San Diego Healthcare System. Hemodynamic parameters were measured using impedance cardiography, and BNP levels were quantified using a rapid immunoassay. All patients with a BNP <100 pg/mL (n=37) had no evidence of congestive heart failure 97% of the time. In those with a BNP >100 pg/mL (601 ±55 pg/mL; n=61), a cardiac index of 2.6 L/min/m2 is 65% sensitive and 88% specific in determining systolic dysfunction. In patients with a BNP >100 pg/mL, a multivariate model consisting of noninvasive hemodynamic measurements was able to predict cardiac deaths, readmissions, and emergency department visits within 90 days with 83% accuracy. The authors conclude that, in patients presenting to an emergency department with dyspnea, the addition of impedance cardiography measurements to BNP level measurements will more effectively diagnose congestive heart failure and determine both the type of heart dysfunction and the severity of illness.

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

“…Although trends between BNP levels and some ICG parameters were seen, the wide degree of scatter implies that some patients diagnosed with CHF based on BNP levels might not receive the same diagnosis based on ICG parameters, and that disparate conclusions might be drawn regarding an individual patient's fluid status, degree of heart failure, and cause of dyspnea when relying on one test over the other. Studies that have examined the use of both BNP and ICG measurements together to assist with the diagnosis of CHF or left ventricular dysfunction (LVD) have described improved accuracy in the diagnosis of these diseases when information from both tests are combined (20,21). In our population, when discharge diagnosis was used as the standard, neither BNP level nor ICG data provided excellent diagnostic accuracy when used individually.…”

Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure

“…In a second retrospective chart review of 64 patients (18), changes in impedance variables were related to changes in NYHA functional class, corridor walk distance, visual analog score, and quality of life over 6 months. In a third study of 98 men seen in an emergency department (19), a combination of brain natriuretic peptide and ICG variables was reported to identify patients at risk of death and hospitalization, but the independent contribution of ICG measurements was not assessed (20). Until the present report, no study had prospectively evaluated the ability of ICG to predict clinical events.…”

Clinical applications of N-terminal pro B-type natriuretic peptide in heart failure and other cardiovascular diseases

“…Natriuretic peptides have become a well-established tool for the diagnosis and risk stratification of patients with heart failure [24][25][26][27][28]. Plasma BNP levels are routinely elevated in patients with heart failure and the degree of elevation correlates well with the extent of clinical heart failure and hemodynamic dysfunction [29].…”