Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room

Möckel, Martin; Müller, Reinhold; Vollert, J.; Müller, Christian; Carl, Angelika; Peetz, D.; Post, Felix; Kohse, J. Klaus; Lackner, Karl J.

doi:10.1373/clinchem.2005.049155

Cited by 26 publications

(18 citation statements)

References 35 publications

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“…It is also noteworthy that we found no differences according to age or sex; this finding contrasts with recent suggestions by Maisel et al (19 ), whose study results might have been confounded by the history of chronic heart failure, which was not addressed. Our results, together with those of Mö ckel et al (20 ), who used a different approach (CART regression), again illustrate that diagnostic tests do not perform equally in all situations; appropriate interpretation depends not only on disease severity, but also on history and various other characteristics of patients (21 ). Our study sample was typical of emergency department recruitment here in France; the problem of identifying heart failure was very satisfactorily modeled, and the gray zone limits proved to be relatively insensitive both to disease prevalence and posttest probability requisites.…”

Section: Discussionsupporting

confidence: 91%

A Gray Zone Assigned to Inconclusive Results of Quantitative Diagnostic Tests: Application to the Use of Brain Natriuretic Peptide for Diagnosis of Heart Failure in Acute Dyspneic Patients

2006

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Background: Most quantitative diagnostic tests do not perfectly differentiate between persons with and without a given disease. We present a simple method to construct a 3-zone partition for quantitative tests results, including positive and negative zones and a gray zone between, and we describe its use in the diagnosis of heart failure by brain natriuretic peptide (BNP) measurement in acute dyspneic patients. Methods: We conducted a prospective cohort study of 699 consecutive patients with acute dyspnea who were treated at the emergency department of 3 participating hospitals. Heart failure (acute or decompensated) was assessed independently at discharge by cardiologists blind to the results of BNP measurements. Results: The discriminatory performance of BNP was insufficient to provide a single cutoff value that could be used to correctly diagnose heart failure in clinical practice. Also, the discriminatory performance differed between patients with and without a history of chronic heart failure. The gray zone of inconclusive results was 167-472 ng/L for those without and 0 -334 ng/L for those with such a history. Diagnosis of the current episode of heart failure by BNP results and history of heart failure was not enhanced by data from any other sources, including electrocardiography.

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Section: Discussionsupporting

confidence: 91%

A Gray Zone Assigned to Inconclusive Results of Quantitative Diagnostic Tests: Application to the Use of Brain Natriuretic Peptide for Diagnosis of Heart Failure in Acute Dyspneic Patients

2006

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“…Nonetheless, consistent — albeit modest — associations with incident events were seen across cohorts for three well-established cardiovascular biomarkers: hsCRP, B-type natriuretic peptide (BNP) and cardiac troponin I. BNP and its prohormone-derived amino terminal split product (NT-proBNP) appear to be particularly promising in diagnosing heart failure and more recently in predicting coronary artery disease. Concentrations of NT-proBNP are related to left ventricular filling pressures and wall stress 25 . Although it is not an inflammatory biomarker like hsCRP, cardiac troponin I is a well-studied marker of myocardial damage 26 .…”

Section: Biomarkers and Imaging For Cardiovascular Diseasesmentioning

confidence: 99%

Anti-inflammatory therapeutics for the treatment of atherosclerosis

Charo

Taub

2011

Nat Rev Drug Discov

267

173

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Atherosclerosis is the primary cause of heart disease and stroke and is thus the underlying pathology of the leading causes of death in the western world. Although risk can be reduced by lowering lipid levels, the equally important contribution of inflammation to the development of cardiovascular disease is not adequately addressed by existing therapies. Here, we summarize the evidence supporting a role for inflammation in the pathogenesis of atherosclerosis, discuss agents that are currently in the clinic and provide a perspective on the challenges faced in the development of drugs that target vascular inflammation.

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“…MR-proANP levels may provide additional diagnostic information for the diagnosis of AHF in addition to BNP or NT-proBNP levels in subgroups for which a correct diagnosis is considered difficult but clinically highly desirable (22)(23)(24).…”

Section: Figure 4 Comparison Of Prognostic Biomarkersmentioning

confidence: 99%