title: Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure.
abstract: B-type natriuretic peptide (BNP) and early diastolic transmitral velocity/tissue Doppler mitral annular velocity (E/Ea) both estimate left ventricular filling pressure, but have not been compared in the diagnosis of congestive heart failure (CHF). One hundred twenty-two hospital inpatients with suspected CHF underwent simultaneous clinical examination, BNP measurement, and comprehensive echo-Doppler examination. The accuracy of BNP and echocardiography was compared with the Framingham criteria diagnosis of CHF. Seventy patients (57%) had clinical CHF, whereas 52 (43%) did not. In all patients, the optimal BNP cutoff was >250 pg/ml (sensitivity 86%, specificity 77%). E/Ea >15 had 83% sensitivity and 82% specificity, whereas comprehensive echo-Doppler had 95% sensitivity and 88% specificity for CHF. In patients with normal ejection fraction, the optimal BNP cutoff was >150 pg/ml (sensitivity 79%, specificity 85%). E/Ea >15 had 79% sensitivity and 93% specificity, whereas comprehensive echo-Doppler had 85% sensitivity and 96% specificity for CHF. In patients with reduced ejection fraction, the optimal BNP cutoff was >300 pg/ml (sensitivity 88%, specificity 60%). E/Ea >15 had 92% sensitivity and 72% specificity, whereas comprehensive echo-Doppler had 96% sensitivity and 80% specificity (p = 0.08 compared with BNP) for CHF. Overall, BNP and E/Ea have similar diagnostic accuracy for CHF in this patient population. In patients with reduced ejection fraction, comprehensive echo-Doppler trended toward higher specificity than BNP for clinical CHF.
authors.affiliation: Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. hishamd@bcm.tmc.edu
authors.forename: Hisham
authors.initials: H
authors.lastname: Dokainish
authors.forename: William A
authors.initials: WA
authors.lastname: Zoghbi
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Lakkis
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quinones
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013781:Texas; D017725:Ventricular Pressure / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain