N‐terminal probrain natriuretic peptide (NT‐proBNP) in the emergency diagnosis and in‐hospital monitoring of patients with dyspnoea and ventricular dysfunction

Abstract

Objective: To evaluate the utility of NT-proBNP in the emergency diagnosis and in-hospital monitoring of patients with acute dyspnoea and ventricular dysfunction. Background: Misdiagnosis of heart failure (HF) is common in the urgent care setting using clinical diagnostic tests. Reports show that BNP is useful to diagnose HF in patients with acute dyspnoea. Methods: Prospective study of 100 patients attending the Emergency Department (ED) for acute dyspnoea. Final diagnosis was determined on the basis of ED data sheets, echocardiography and pulmonary function tests. NT-proBNP levels were obtained on admission, at 24 h and at day 7. Results: Patients with ventricular dysfunction were sub-classified into decompensated HF and masked HF, defined as HF with concomitant signs of pulmonary disease. Decompensated and masked HF patients had significantly higher NT-proBNP values than patients with non-cardiac dyspnoea (normal ventricular function) (920"140 and 978"363 vs. 50"15 pmolyL; P-0.001 and P-0.01, respectively). The mean area under the ROC curve for NT-proBNP was 0.957 (95% CI, 0.918 to 0.996, P-0.001). In multiple logistic-regression analysis NT-proBNP)115 pmolyl was the strongest independent predictor of ventricular dysfunction (odds ratio 45.4; 95% CI: 4.5-452.3). At day 7, a significant and similar reduction in NT-proBNP was observed in the two groups of patients with ventricular dysfunction (P-0.001 vs. admission values), but complete clinical resolution was less frequent in masked HF patients (P-0.05 vs. decompensated HF). Conclusions: NT-proBNP is a new candidate marker for the detection and exclusion of ventricular dysfunction in patients attending the ED for acute dyspnoea. NT-proBNP may also serve to monitor outcome during hospitalization.

Comparative accuracy of NT‐proBNP and MR‐proANP for the diagnosis of acute heart failure in dyspnoeic patients

“…First, the diagnostic performance of both NT‐proBNP and MR‐proANP for the diagnosis of AHF is excellent ( Figure  2 A ) confirming previous studies1, 2, 3, 16, 17 and thus fully supporting current guideline recommendations on the use of NPs for rule‐out of AHF 18…”

“…For this purpose, brain‐type natriuretic peptide (BNP), N‐terminal pro brain‐type natriuretic peptide (NT‐proBNP) or atrial natriuretic peptide (ANP) collectively designated as natriuretic peptides (NPs) have been recommended by practice guidelines for rule‐out used at pre‐specified and validated cut‐offs 1, 2, 3, 4. However, the performance of NP levels for the diagnosis of AHF has been reported to be less accurate in the setting of renal failure, and obesity as well as advanced age may confound interpretation of NP levels.…”

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

“…Using a cut-off point of 100 pg/mL, the diagnostic accuracy was 83%. Similarly favourable results have been demonstrated with the use of the laboratory-based NTproBNP assay (194,195). In the single-institution N-terminal Pro-BNP Investigation of Dyspnea in the Emergency department (PRIDE) study (195), 600 patients presenting to an emergency department with dyspnea were prospectively evaluated.…”

The Diagnostic Value of B Natriuretic Peptide in Elderly Patients with Acute Dyspnea

“…Inappropriate emergency treatment occurred in 162 (32%) patients, and led to a higher mortality (25% versus 11%; p Ͻ 0.001), highlighting the importance of an early accurate treatment in the ED. Numerous studies have evaluated and validated both natriuretic peptides in the diagnosis of CHF in middle-aged patients with acute dyspneoa 26,[30][31][32][33][34][35][36][37][38][39][40][41] ( Tables 2 and 3). All studies used the same methodology, with a measurement of BNP at admission in dyspneic patients in the emergency room.…”