N‐terminal pro‐brain natriuretic peptide for discriminating between cardiac and non‐cardiac dyspnoea

Abstract

Aim: Evaluation of N-terminal pro-brain natriuretic peptide (NT-proBNP) to confirm or disprove heart failure in community patients complaining of dyspnoea. Methods and results: General practitioners referred 345 consecutive patients complaining of dyspnoea to our hospital-based clinic, where a diagnosis was established based on a combined programme for heart and lung diseases including echocardiography. The level of NT-proBNP in plasma was also measured. The mean (S.D.) concentration of NT-proBNP in patients with heart failure was significantly higher, 189 (270) pmolyl in patients with heart failure (ns81), than in patients with non-cardiac dyspnoea (ns264), 17 (38) pmolyl (P-0.001). In patients 050 years NT-proBNP -11 pmolyl for men and -17 pmolyl for women excluded heart failure with a negative predictive value of 97% while the positive predictive value was 53%, the sensitivity 95% and the specificity 68%. Areas under receiver operator characteristic curves for men and women were 0.93 and 0.90, respectively. Conclusion: In a relevant setting of primary care patients complaining of dyspnoea, NTproBNP seems promising for disproval of heart failure, and this test may reduce the need for echocardiographic screening with 50%. However, the discrimination levels of NT-proBNP found in this study may need prospective confirmation, before the test can be generally recommended.

Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure

“…By ROC analysis, BNP showed good diagnostic power to detect HF (area under the curve, 0.94 -0.98), with similar performance described for NTproBNP in 2 previous studies involving primary care patients with dyspnea referred for echocardiography (33,34 ). Furthermore, our data confirm that decisional values should vary also according to the population of patients tested (35 ).…”

Unrecognized Heart Failure and Chronic Obstructive Pulmonary Disease (COPD) in Frail Elderly Detected Through a Near-Home Targeted Screening Strategy

“…29,31,32 Two separate studies by Nielsen et al 31,32 in Denmark found newly detected HF in 27% and 23% and new COPD in 32% and 48% of cases and no underlying reasons in 15% and 18% of cases, respectively. Pedersen et al 29 considered cardiac and/or pulmonary diseases present in 69% of patients referred to the outpatient clinic for dyspnea (median age, 71.5 years; 31% men), classifying 21% with a new diagnosis of heart disease and 53% with pulmonary disease.…”

Diagnostic Value of Serum N-Terminal Pro B-Type Natriuretic Peptide (Nt-Probnp) for Left Ventricular Dysfunction in Hypertensive Cases.

“…The elevated NT-proBNP levels are strongly associated with structural and functional abnormalities of left ventricle along with systolic dysfunction [18]. However, the recent studies shown that NT-proBNP also raised in heart failure and can be used as marker for mortality in acute coronary syndrome and myocardial infarction [19]. The NT-proBNP is mostly cleared from renal system and any dysfunction or failure of renal system reveals the abnormality in the renal function.…”