N-terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea.
OBJECTIVE
Evaluation of N-terminal pro-brain natriuretic peptide (NT-proBNP) to confirm or disprove heart failure in community patients complaining of dyspnoea.


RESULTS
General practitioners referred 345 consecutive patients complaining of dyspnoea to our hospital-based clinic, where a diagnosis was established based on a combined programme for heart and lung diseases including echocardiography. The level of NT-proBNP in plasma was also measured. The mean (S.D.) concentration of NT-proBNP in patients with heart failure was significantly higher, 189 (270) pmol/l in patients with heart failure (n=81), than in patients with non-cardiac dyspnoea (n=264), 17 (38) pmol/l (P<0.001). In patients > or = 50 years NT-proBNP <11 pmol/l for men and <17 pmol/l for women excluded heart failure with a negative predictive value of 97% while the positive predictive value was 53%, the sensitivity 95% and the specificity 68%. Areas under receiver operator characteristic curves for men and women were 0.93 and 0.90, respectively.


CONCLUSIONS
In a relevant setting of primary care patients complaining of dyspnoea, NT-proBNP seems promising for disproval of heart failure, and this test may reduce the need for echocardiographic screening with 50%. However, the discrimination levels of NT-proBNP found in this study may need prospective confirmation, before the test can be generally recommended.
Nielsen
Lene Svendstrup
LS
Department of Internal Medicine, Haderslev Hospital, 6100 Haderslev, Denmark. lene.svendstrup@dadlnet.dk
Svanegaard
Jens
J
Klitgaard
Niels Anders
NA
Egeblad
Henrik
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve
D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain