title: The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study.
abstract: The utility of aminoterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department to rule out acute congestive heart failure (CHF) and the optimal cutpoints for this use are not established. We conducted a prospective study of 600 patients who presented in the emergency department with dyspnea. The clinical diagnosis of acute CHF was determined by study physicians who were blinded to NT-proBNP results. The primary end point was a comparison of NT-proBNP results with the clinical assessment of the managing physician for identifying acute CHF. The median NT-proBNP level among 209 patients (35%) who had acute CHF was 4,054 versus 131 pg/ml among 390 patients (65%) who did not (p <0.001). NT-proBNP at cutpoints of >450 pg/ml for patients <50 years of age and >900 pg/ml for patients >or=50 years of age were highly sensitive and specific for the diagnosis of acute CHF (p <0.001). An NT-proBNP level <300 pg/ml was optimal for ruling out acute CHF, with a negative predictive value of 99%. Increased NT-proBNP was the strongest independent predictor of a final diagnosis of acute CHF (odds ratio 44, 95% confidence interval 21.0 to 91.0, p <0.0001). NT-proBNP testing alone was superior to clinical judgment alone for diagnosing acute CHF (p = 0.006); NT-proBNP plus clinical judgment was superior to NT-proBNP or clinical judgment alone. NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting.
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. jjanuzzi@partners.org <jjanuzzi@partners.org>
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.forename: Annabel A
authors.initials: AA
authors.lastname: Chen
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Krauser
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Renee
authors.initials: R
authors.lastname: Cameron
authors.forename: J Tobias
authors.initials: JT
authors.lastname: Nagurney
authors.forename: Claudia U
authors.initials: CU
authors.lastname: Chae
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: David F
authors.initials: DF
authors.lastname: Brown
authors.forename: Stacy
authors.initials: S
authors.lastname: Foran-Melanson
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Sluss
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.forename: Kent B
authors.initials: KB
authors.lastname: Lewandrowski
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000209:etiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000032:analysis*; D015588:Observer Variation; D010446:Peptide Fragments / Q000032:analysis*; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain