title: Impact of atrial fibrillation on the diagnostic performance of B-type natriuretic peptide concentration in dyspneic patients: an analysis from the breathing not properly multinational study.
abstract: OBJECTIVE
  This study was designed to assess the diagnostic performance of B-type natriuretic peptide (BNP) in the diagnosis of acute congestive heart failure (CHF) in patients with permanent/paroxysmal atrial fibrillation (AF) presenting with acute dyspnea.
  
  
  BACKGROUND
  It is unknown to what extent AF affects the diagnostic performance of BNP in patients presenting with acute dyspnea.
  
  
  METHODS
  We studied 1,431 patients drawn from a cohort of patients (n = 1,586) with acute dyspnea who had BNP levels measured on arrival. Patients were prospectively classified according to the presence or absence of permanent/paroxysmal AF.
  
  
  RESULTS
  In total, 292 patients had permanent/paroxysmal AF. In patients without HF, permanent/paroxysmal AF was associated with significantly higher BNP levels (p = 0.001). Conversely, in patients with HF, BNP levels did not differ significantly between patients with and without AF (p = 0.533). A BNP cutoff value of 100 pg/ml had a specificity of 40% and 79% for the diagnosis of acute HF in patients with and without AF, respectively. The areas under the receiver-operating characteristic curves were 0.84 (95% confidence interval 0.78 to 0.89) and 0.91 (95% confidence interval 0.89 to 0.93) for patients with and without AF, respectively.
  
  
  CONCLUSIONS
  In patients without, but not in those with HF, the presence of AF is associated with higher circulating BNP levels, suggesting that a higher diagnostic threshold should be used in patients with AF.
authors.affiliation: Ullevål University Hospital, Oslo, Norway.
authors.forename: Cathrine Wold
authors.initials: CW
authors.lastname: Knudsen
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Arne
authors.initials: A
authors.lastname: Westheim
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Philippe
authors.initials: P
authors.lastname: Duc
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D015331:Cohort Studies; D004417:Dyspnea / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D020097:Natriuretic Peptide, Brain