The effects of ejection fraction on N-terminal ProBNP and BNP levels in patients with acute CHF: analysis from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study.
BACKGROUND
Limited data exist regarding the impact of left ventricular ejection fraction (LVEF) on N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) levels in patients with acute congestive heart failure (CHF).


RESULTS
LVEF data were analyzed for 153 subjects with acute CHF. LVEF > or =50% was defined as non-systolic CHF (NS-CHF); LVEF >50% was defined as systolic CHF (S-CHF). 76 subjects (49.7%) had NS-CHF. Median NT-proBNP and BNP levels were significantly higher among patients with S-CHF (6196 pg/mL, 592 pg/mL, respectively) compared with those patients with NS-CHF (2849 pg/mL, 259 pg/mL, respectively). With optimal cut-points, a false-negative rate of 7% was observed for both assays among patients with S-CHF. Among patients with NS-CHF, BNP had a significantly higher false-negative rate (20%) than did NT-proBNP (9%; P < .001 for difference). NT-proBNP, but not BNP, significantly correlated with CHF symptom severity among patients with NS-CHF.


CONCLUSIONS
Levels of both NT-proBNP and BNP are significantly lower in patients with NS-CHF; however, in contrast to NT-proBNP, BNP may be falsely negative in up to 20% of patients with NS-CHF and does not correlate with symptom severity in NS-CHF. NT-proBNP appears superior to BNP for the evaluation of suspected acute CHF in patients with preserved LVEF.
O'Donoghue
Michelle
M
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Chen
Annabel
A
Baggish
Aaron L
AL
Anwaruddin
Saif
S
Krauser
Daniel G
DG
Tung
Roderick
R
Januzzi
James L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology*
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain