Utility of B‐natriuretic peptide (BNP) in the diagnosis of congestive heart in an urgent care setting

Background-Although Doppler echocardiography has been used to identify abnormal left ventricular (LV) diastolic filling dynamics, inherent limitations suggest the need for additional measures of diastolic dysfunction. Because data suggest that B-natriuretic peptide (BNP) partially reflects ventricular pressure, we hypothesized that BNP levels could predict diastolic abnormalities in patients with normal systolic function. Methods and Results-We studied 294 patients referred for echocardiography to evaluate ventricular function. Patients with abnormal systolic function were excluded. Cardiologists making the assessment of LV function were blinded to BNP levels. Patients were classified as normal, impaired relaxation, pseudonormal, and restrictivelike filling patterns.Patients diagnosed with evidence of abnormal LV diastolic function (nϭ119) had a mean BNP concentration of 286Ϯ31 pg/mL; those in the normal LV group (nϭ175) had a mean BNP concentration of 33Ϯ3 pg/mL. Patients with restrictivelike filling patterns on echocardiography had the highest BNP levels (408Ϯ66 pg/mL), and patients with symptoms had higher BNP levels in all diastolic filling patterns. The area under the receiver-operating characteristic curve for BNP to detect any diastolic dysfunction was 0.92 (95% CI, 0.87 to 0.95; PϽ0.001). A BNP value of 62 pg/mL had a sensitivity of 85%, a specificity of 83%, and an accuracy of 84% for detecting diastolic dysfunction. Conclusions-A rapid assay for BNP can reliably detect the presence of diastolic abnormalities on echocardiography. In patients with normal systolic function, elevated BNP levels and diastolic filling abnormalities might help to reinforce the diagnosis diastolic dysfunction. (Circulation. 2002;105:595-601.)

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“…Precision, analytical sensitivity, interferences, and stability have all been previously described. 9 …”

Section: Measurement Of Bnp Levelsmentioning

confidence: 99%

Utility of B-Natriuretic Peptide in Detecting Diastolic Dysfunction

et al. 2002

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“…Davis et al, 6 who measured the natriuretic hormones atrial natriuretic peptide and BNP in 52 patients presenting with acute dyspnea, found that admission plasma BNP concentrations more accurately reflected the final diagnosis than did ejection fraction or concentration of plasma atrial natriuretic peptide. Dao et al 7 used the newly available point-of-care rapid assay for BNP (Triage Assay, Biosite Inc) in 250 patients presenting to the San Diego VA Healthcare Urgent Care Center. Patients diagnosed with CHF (nϭ97) had a mean BNP concentration of 1076Ϯ138 pg/mL, whereas the non-CHF group (nϭ139) had a mean BNP concentration of 38Ϯ4 pg/mL.…”

Section: Bnp In the Diagnosis Of Dyspneamentioning

confidence: 99%

B-Type Natriuretic Peptide Levels: Diagnostic and Prognostic in Congestive Heart Failure

Maisel

2002

Circulation

146

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“…1 Plasma BNP concentrations are elevated in adults with congestive heart failure and can distinguish cardiac from noncardiac causes of dyspnea, correlate with the severity of heart failure symptoms, and predict mortality and hospital readmission. [2][3][4][5][6][7][8][9] Because of this relationship, plasma BNP concentrations have become a useful tool in both the acute care and outpatient settings to facilitate with the diagnosis, triage, and risk stratification of adult patients with congestive heart failure. 10 -13 …”

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confidence: 99%