Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea.
OBJECTIVE
We compared the accuracy of B-type natriuretic peptide (BNP) assay with Doppler echocardiography for the diagnosis of decompensated congestive left-heart failure (CHF) in patients with acute dyspnea.


BACKGROUND
Both BNP and Doppler echocardiography have been described as relevant diagnostic tests for heart failure.


METHODS
One hundred sixty-three consecutive patients with severe dyspnea underwent BNP assay and Doppler echocardiogram on admission. The accuracy of the two methods for etiologic diagnosis was compared on the basis of the final diagnoses established by physicians who were blinded to the BNP and Doppler findings.


RESULTS
The final etiologic diagnosis was CHF in 115 patients. Twenty-four patients (15%) were misdiagnosed at admission. The BNP concentration was 1,022 +/- 742 pg/ml in the CHF subgroup and 187 +/- 158 pg/ml in the other patients (p < 0.01). A BNP cutoff of 300 pg/ml correctly classified 88% of the patients (odds ratio [OR] 85 [19 to 376], p < 0.0001), but a high negative predictive value (90%) was only obtained when the cutoff was lowered to 80 pg/ml. The etiologic value of BNP was low in patients with values between 80 and 300 pg/ml (OR 1.85 [0.4 to 7.8], p = 0.4) and also in patients who were studied very soon after onset of acute dyspnea. Among the 138 patients with assessable Doppler findings, a "restrictive" mitral inflow pattern had a diagnostic accuracy for CHF of 91% (OR 482 [77 to 3,011], p < 0.0001), regardless of the BNP level.


CONCLUSIONS
Bedside BNP measurement and Doppler echocardiography are both useful for establishing the cause of acute dyspnea. However, Doppler analysis of the mitral inflow pattern was more accurate, particularly in patients with intermediate BNP levels or "flash" pulmonary edema.
Logeart
Damien
D
Service de Cardiologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Gal Leclerc, 92110 Clichy, France. damien.logeart@bjn.ap-hop-paris.fr
Saudubray
Carole
C
Beyne
Pascale
P
Thabut
Gabriel
G
Ennezat
Pierre-Vladimir
PV
Chavelas
Christophe
C
Zanker
Caroline
C
Bouvier
Erik
E
Solal
Alain Cohen
AC
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000378:metabolism*; D001681:Biological Assay; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism*; D015150:Echocardiography, Doppler; D005260:Female; D005602:France; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor