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Previous Volume 347:161-167 July 18, 2002 Number 3 Next

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ABSTRACT

Background B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension.

Methods We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay.

Results The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure.

Conclusions Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.

Source Information

From the University of California, San Diego, Veterans Affairs Medical Center, San Diego (A.S.M, P.K., P.C., R.K.); Henry Ford Hospital, Detroit (R.M.N., J.M.); the University of Pennsylvania, Philadelphia (J.E.H., H.C.H.); Hôpital Bichat, Paris (P.D., P.G.S.); Ullevål University Hospital, Oslo, Norway (T.O., A.W., C.W.K.); the University of Cincinnati College of Medicine, Cincinnati (A.B.S.); the University of Kentucky College of Medicine, Lexington (W.T.A.); Hartford Hospital, Hartford, Conn. (A.H.B.W., A.P.); and the University of Missouri–Kansas City School of Medicine, Truman Medical Center, Kansas City (P.A.M.).

Address reprint requests to Dr. Maisel at Veterans Affairs Medical Center Cardiology 111-A, 3350 La Jolla Village Dr., San Diego, CA 92161, or at amaisel{at}ucsd.edu.

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B-Type Natriuretic Peptide in Heart Failure
Colli A., Fraquelli M., Conte D., Hassan Y., Shapira A. R., Hassan S., Foote R. S., Pearlman J. D., Maisel A. S., Clopton P., McCullough P. A.
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N Engl J Med 2002; 347:1976-1978, Dec 12, 2002. Correspondence

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