PMID- 17324304
OWN - NLM
STAT- MEDLINE
DCOM- 20070403
LR  - 20191026
IS  - 1481-8035 (Print)
IS  - 1481-8035 (Linking)
VI  - 8
IP  - 4
DP  - 2006 Jul
TI  - Potential impact of N-terminal pro-BNP testing on the emergency department 
      evaluation of acute dyspnea.
PG  - 251-8
AB  - OBJECTIVES: Measurement of the serum B-type natriuretic peptide (BNP) level and 
      more recently its precursor, N-terminal proBNP (NT-proBNP), has been advocated to 
      facilitate the diagnosis of heart failure in the emergency department (ED). We 
      sought to determine the potential impact of adding NT-proBNP testing to the 
      routine evaluation of emergency patients with acute dyspnea. METHODS: This 
      prospective cohort study enrolled a convenience sample of acutely dyspneic 
      patients at a tertiary care ED. We excluded trauma patients and those under 30 
      years of age. Patients underwent standard evaluation, including radiography when 
      indicated. At the point of final diagnosis and blinded to the NT-proBNP result, 
      physicians documented the likelihood that heart failure accounted for the 
      patient's acute dyspnea on a 7-point Likert scale, the data from which was 
      subsequently collapsed to 3 categories for analysis purposes. The primary outcome 
      was the agreement between clinical impression and the NT-proBNP assay classified 
      using manufacturer-recommended, age-specific cut-offs. Newly proposed cut-offs 
      from a recent study were also evaluated. RESULTS: One hundred and twenty-nine 
      patients making 139 ED visits were enrolled (median age 76 years; 59% admitted). 
      The serum NT-proBNP assay was positive in 119 (86%, 95% confidence interval [CI] 
      80%-91%) cases, including 75% (43/57, 95% CI 62%-86%) of the cases that the 
      treating physician felt were not caused by heart failure, and 86% (25/29, 95% CI 
      68%-96%) where the treating physician was unsure. The median NT-proBNP 
      concentration was higher in patients clinically believed to have heart failure 
      rather than pneumonia or chronic obstructive pulmonary disease; however, the 
      ranges of these values overlapped extensively (median 4361 pg/mL; interquartile 
      range [IQR] 2386-10877 v. 1651 pg/mL; IQR 370-4745, respectively). CONCLUSIONS: 
      There is high discordance between the clinical impression of treating physicians 
      and NT-proBNP concentrations, notably in patients who are believed not to have 
      heart failure. Although the reference standard of ED diagnosis is imperfect, the 
      broad overlap in NT-proBNP concentrations suggests poor specificity in this 
      target patient population. The introduction of routine ED NT-proBNP testing using 
      the current cut-offs would be expected to result in substantial indirect costs 
      from further diagnostic testing. It remains unclear whether the introduction of 
      this diagnostic test would have a positive impact on clinically relevant patient 
      outcomes.
FAU - Murray, Heather
AU  - Murray H
AD  - Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
FAU - Cload, Bruce
AU  - Cload B
FAU - Collier, Christine P
AU  - Collier CP
FAU - Sivilotti, Marco L A
AU  - Sivilotti ML
LA  - eng
PT  - Journal Article
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
CIN - CJEM. 2006 Jul;8(4):259-61. doi: 10.1017/s1481803500013804. PMID: 17324305
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers/blood
MH  - Dyspnea/blood/epidemiology/*etiology
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Heart Failure/blood/diagnosis
MH  - Humans
MH  - Likelihood Functions
MH  - Lung Diseases/diagnosis/epidemiology
MH  - Male
MH  - Natriuretic Peptide, Brain/*blood
MH  - Ontario/epidemiology
MH  - Peptide Fragments/*blood
MH  - Prospective Studies
EDAT- 2007/02/28 09:00
MHDA- 2007/04/04 09:00
CRDT- 2007/02/28 09:00
PHST- 2007/02/28 09:00 [pubmed]
PHST- 2007/04/04 09:00 [medline]
PHST- 2007/02/28 09:00 [entrez]
AID - 94080DD02BF447D1A126B75C73205713 [pii]
AID - 10.1017/s1481803500013798 [doi]
PST - ppublish
SO  - CJEM. 2006 Jul;8(4):251-8. doi: 10.1017/s1481803500013798.