Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting.

By Quyen Dao, P. Krishnaswamy, R. Kazanegra, A. Harrison, R. Amirnovin, L. Lenert, P. Clopton, J. Alberto, P. Hlavin, A. Maisel. Journal of the American College of Cardiology, 2001

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OBJECTIVES The goal of this study was to evaluate the utility of a rapid "bedside" technique for measurement of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in an urgent-care setting. BACKGROUND B-type natriuretic peptide is a protein secreted from the cardiac ventricles in response to pressure overload. One potential application of measurements of BNP in blood is distinguishing dyspnea due to CHF from other causes. METHODS B-type natriuretic peptide concentrations were measured in a convenience sample of 250 predominantly male (94%) patients presenting to urgent-care and emergency departments of an academic Veteran's Affairs hospital with dyspnea. Results were withheld from clinicians. Two cardiologists retrospectively reviewed clinical data (blinded to BNP measurements) and reached a consensus opinion on the cause of the patient's symptoms. This gold standard was used to evaluate the diagnostic performance of the BNP test. RESULTS The mean BNP concentration in the blood of patients with CHF (n = 97) was higher than it was in patients without (1,076 +/- 138 pg/ml vs. 38 +/- 4 pg/ml, p < 0.001). At a blood concentration of 80 pg/ml, BNP was an accurate predictor of the presence of CHF (95%); measurements less than this had a high negative predictive value (98%). The overall C-statistic was 0.97. In multivariate analysis, BNP measurements added significant, independent explanatory power to other clinical variables in models predicting which patients had CHF. The availability of BNP measurements could have potentially corrected 29 of the 30 diagnoses missed by urgent-care physicians. CONCLUSIONS B-type natriuretic peptide blood concentration measurement appears to be a sensitive and specific test to diagnose CHF in urgent-care settings.

Subfields: Cardiology and Cardiovascular Medicine, Complementary and alternative medicine

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In Cardiology and Cardiovascular Medicine

Citations in the corpus

[Executive summary of the guidelines on the diagnosis and treatment of acute heart failure]. (2005, background): “Otherwise, BNP has a good negative predictive value to exclude heart failure.(33) Various clinical conditions may affect the BNP concentration including renal failure and septicaemia.”
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. (2017, background): “chronic ambulatory HF (15-21) or in the setting of acute care with decompensated HF (22-30), especiall y”
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. (2002, background): “However, it has been widely investigated as a biochemical marker of morbidity and mortality in patients with known HF (11) and as an aid in differentiating dyspnea due to HF from dyspnea due to other causes in an emergency setting ( 12 ).”