Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure
Alan S. Maisel, M.D., Padma Krishnaswamy, M.D., Richard M. Nowak, M.D., M.B.A., James McCord, M.D., Judd E. Hollander, M.D., Philippe Duc, M.D., Torbjørn Omland, M.D., Ph.D., Alan B. Storrow, M.D., William T. Abraham, M.D., Alan H.B. Wu, Ph.D., Paul Clopton, M.S., Philippe G. Steg, M.D., Arne Westheim, M.D., Ph.D., M.P.H., Catherine Wold Knudsen, M.D., Alberto Perez, M.D., Radmila Kazanegra, M.D., Howard C. Herrmann, M.D., Peter A. McCullough, M.D., M.P.H., for the Breathing Not Properly Multinational Study Investigators
Methods We conducted a prospective study of 1586 patients whocame to the emergency department with acute dyspnea and whoseB-type natriuretic peptide was measured with a bedside assay.The clinical diagnosis of congestive heart failure was adjudicatedby two independent cardiologists, who were blinded to the resultsof the B-type natriuretic peptide assay.
Results The final diagnosis was dyspnea due to congestive heartfailure in 744 patients (47 percent), dyspnea due to noncardiaccauses in 72 patients with a history of left ventricular dysfunction(5 percent), and no finding of congestive heart failure in 770patients (49 percent). B-type natriuretic peptide levels bythemselves were more accurate than any historical or physicalfindings or laboratory values in identifying congestive heartfailure as the cause of dyspnea. The diagnostic accuracy ofB-type natriuretic peptide at a cutoff of 100 pg per milliliterwas 83.4 percent. The negative predictive value of B-type natriureticpeptide at levels of less than 50 pg per milliliter was 96 percent.In multiple logistic-regression analysis, measurements of B-typenatriuretic peptide added significant independent predictivepower to other clinical variables in models predicting whichpatients had congestive heart failure.
Conclusions Used in conjunction with other clinical information,rapid measurement of B-type natriuretic peptide is useful inestablishing or excluding the diagnosis of congestive heartfailure 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.
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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A correction has been published: N Engl J Med 2002;347(14):1126.
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