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.
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.
Knudsen
Cathrine Wold
CW
Ullevål University Hospital, Oslo, Norway.
Omland
Torbjørn
T
Clopton
Paul
P
Westheim
Arne
A
Wu
Alan H B
AH
Duc
Philippe
P
McCord
James
J
Nowak
Richard M
RM
Hollander
Judd E
JE
Storrow
Alan B
AB
Abraham
William T
WT
McCullough
Peter A
PA
Maisel
Alan
A
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
D020097:Natriuretic Peptide, Brain