The utility of B-type natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review (original) (raw)
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CJEM, 2006
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. 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 classi...
Annals of Internal Medicine, 2009
Background: B-type natriuretic peptide (BNP) is used to diagnose heart failure, but the effects of using the test on all dyspneic patients is uncertain. Objective: To assess whether BNP testing alters clinical outcomes and health services use of acutely dyspneic patients. Design: Randomized, single-blind study. Patients were assigned to a treatment group through randomized numbers in a sealed envelope. Patients were blinded to the intervention, but clinicians and those who assessed trial outcomes were not. Setting: 2 Australian teaching hospital emergency departments. Patients: 612 consecutive patients who presented with acute severe dyspnea from August 2005 to March 2007. Intervention: BNP testing (n ϭ 306) or no testing (n ϭ 306). Measurements: Admission rates, length of stay, and emergency department medications (primary outcomes); mortality and readmission rates (secondary outcomes). Results: There were no between-group differences in hospital admission rates (85.6% [BNP group] vs. 86.6% [control group]; difference , Ϫ1.0 percentage point [95% CI, Ϫ6.5 to 4.5 percentage points]; P ϭ 0.73), length of admission (median, 4.4 days [interquartile range, 2 to 9 days] vs. 5.0 days [interquartile range, 2 to 9 days]; P ϭ 0.94), or management of patients in the emergency department. Test discrimination was good (area under the receiveroperating characteristic curve, 0.87 [CI, 0.83 to 0.91]). Adverse events were not measured. Limitation: Most patients were very short of breath and required hospitalization; the findings might not apply for evaluating patients with milder degrees of breathlessness. Conclusion: Measurement of BNP in all emergency department patients with severe shortness of breath had no apparent effects on clinical outcomes or use of health services. The findings do not support routine use of BNP testing in all severely dyspneic patients in the emergency department.
International Journal of Cardiology, 2010
Objectives: This study aimed to examine the influence of history of heart failure (HF) on circulating levels, diagnostic accuracy and prognostic value of B-type natriuretic peptide (BNP) in patients presenting with all cause dyspnea at the emergency department. Background: BNP has been shown to be very helpful in diagnosis and prognosis of HF. Due to chronically elevated cardiac filling pressures, patients with a history of HF might have higher BNP levels and therefore diagnostic and prognostic properties of BNP may be affected. Methods: We analyzed circulating levels, diagnostic accuracy and prognostic value of BNP in 388 patients without a previous history of HF and compared these to data to 64 patients with a history of HF included in the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) Study. Results: Baseline BNP levels were higher in patients with a history of HF (median 814 pg/ml [353-1300 pg/ml] vs. 216 pg/ml [45-801 pg/ ml], p b 0.001). Diagnostic accuracy of BNP to identify HF was comparable in patients with (AUC = 0.804; 95% CI 0.628-0.980) and in patients without history of HF (AUC = 0.883; 95% CI 0.848-0.919, p = 0.389). Prognostic ability of BNP to predict one-year mortality was lower in overall patients with history of HF (AUC = 0.458; 95%CI 0.294-0.622) compared to patients without history of HF (AUC = 0.710; 95% CI 0.653-0.768, p b 0.05). Conclusions: In patients with history of HF, BNP levels retain diagnostic accuracy. Ability to predict one-year mortality was decreased in unselected patients, but not in patients with acute HF-induced dyspnea.
BNP IN DISCRIMINATION OF CARDIAC (HEART FAILURE) AND NON-CARDIAC (PULMONARY) DYSPNEA
Objective: To evaluate the utility of BNP (B-type natriuretic peptide) in discrimination of cardiac and non-cardiac (Pulmonary) dyspnea. Background: Traditionally the diagnosis of heart failure has been made on the basis of presence of certain signs and symptoms .In case of chronic outpatients, where the physical signs are usually prominent, the diagnosis is easy, whereas in elderly who present to the emergency department with acute dyspnea it is sometimes challenging and often difficult particularly when associated chronic pulmonary diseases are also present. Elevated plasma B-type natriuretic peptide (BNP) has been demonstrated to be a powerful marker for diagnosis and discrimination of dyspnea in the setting of heart failure from a non-cardiac dyspnea. Methods: We studied 105 subjects (mean age 51.57±5.11 yr), 35 presenting to the emergency department with dyspnea due to HF [New York Heart Association (NYHA) class III], 35 presenting to the emergency department with dyspnea due to pulmonary causes and 35 normal controls, in Dr. HMI Institute of Pharmacology & Herbal Sciences in collaboration with Arif Medical complex Karachi From June 2004 to Dec 2004. Results: Baseline characteristics of the two groups were similar. Their serum levels of BNP were estimated and compared. Levels of serum BNP in patients with HF were found to be significantly high as compared to the non-cardiac dyspneic patients and control subjects [680±45.20,375.21±25.63 and 78.45±16.44 respectively] Conclusion: BNP level can be a useful tool in differentiation of a heart failure patient from a non-cardiac patient presenting to the emergency department with dyspnea.
Brain Natriuretic Peptide in the Evaluation of Emergency Department Dyspnea: Is There a Role?
The Journal of Emergency Medicine, 2012
Background-Acute decompensated congestive heart failure (ADCHF) is a common etiology of dyspnea in emergency department (ED) patients. Delayed diagnosis of ADCHF increases morbidity and mortality. Two cardiac biomarkers, N-terminal-pro brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) have demonstrated excellent sensitivity in diagnostic accuracy studies, but the clinical impact on patient-oriented outcomes of these tests remains in question.
Cureus
Introduction Dyspnea is among the most prevalent symptoms experienced by patients presenting as an emergency. The underlying etiology is often a cardiovascular or pulmonary condition, of which heart failure is recognized as a major contributor. The differentials are primarily established based on the patient's clinical presentation and physical examinations but are not conclusive. Of the various investigations undertaken to determine the cause of dyspnea, the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) was found to be significantly associated with heart failure. Its level has been proven to be in direct correlation with the severity of the disease. This study demonstrates the usability of an economical rapid test kit in measuring NT-ProBNP levels to help differentiate the cause of dyspnea in the presenting patient in a resource-limited setting. Methodology We studied 115 participants from a tertiary care center in India, which included 70 males and 45 females aged ≤30 to ≥75 years, presenting with shortness of breath. Rapid NT-ProBNP tests were conducted alongside recording their symptoms, vitals, examination findings, and other parameters. They were also classified according to New York Heart Association (NYHA) Classification, and further investigated. Results The study elucidated the efficacy and accuracy of the rapid kits in determining NT-ProBNP levels, and its relation with the severity and prognosis of heart failure. The kits utilized had a sensitivity of greater than 93% for ruling out heart failure as a cause of dyspnea, and a sensitivity of greater than 96% for ruling out elevated NT-ProBNP levels in general. Other parameters such as presenting symptoms and vitals were also analyzed, establishing a correlation with NT-ProBNP levels. Conclusion This study guided us in understanding the effective utilization of the rapid testing kits for emergency care, minimizing the burden on other limited resources. The lower cost and ease of use would serve as a quick means of reaching a conclusive diagnosis, especially in an emergency, which in turn would aid in receiving timely and specific treatment. These kits could act as a stepping stone in creating a sustainable and efficient healthcare system for patients as well as healthcare workers.