[B-type natriuretic peptide and clinical judgement in the diagnosis of heart failure in patients presenting with acute dyspnoea].
BACKGROUND
B-type natriuretic peptide (BNP) is increased in left ventricular dysfunction and congestive heart failure e. The aim of the study was to determine the diagnostic accuracy of BNP and the degree to which BNP adds to clinical judgement in the diagnosis of heart failure.


METHODS
The BNP Multinational Study was a seven-centre prospective study of 1586 patients presenting to emergency departments with acute dyspnoea who had BNP levels measured with a rapid, point-of-care device on arrival. 1538 (97%) had pre-test probability of congestive heart failure determined from 0-100% by the attending physician in the emergency department who was blinded to the BNP levels. The final diagnosis was adjudicated by two independent cardiologists, also blinded to BNP results, who reviewed all clinical data and standardised congestive heart failure scores.


RESULTS
The final diagnosis was congestive heart failure in 722 (47%) patients. Pre-test probability of this condition > or = 80% as determined by the attending physician had a sensitivity of 49% and specificity of 96 % for correct diagnosis. BNP > or = 100 pg/ml had a sensitivity of 90% and a specificity of 73% for correct diagnosis. In determining the correct diagnosis (congestive heart failure or not), adding BNP to clinical judgement would have enhanced diagnostic accuracy from 74% to 81%.


CONCLUSIONS
Measurement of BNP adds to the clinical information in the diagnosis of congestive heart failure in patients presenting with acute dyspnoea.
Knudsen
Cathrine Wold
CW
Hjertemedisinsk avdeling, Ullevål universitetssykehus, 0407 Oslo. cath_wk@hotmail.com
Westheim
Arne
A
Omland
Torbjørn
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D015415:Biomarkers; D009320:Atrial Natriuretic Factor