[Usefulness of NTproBNP in the emergency management of patients with severe dyspnea and an uncertain heart failure diagnosis].
OBJECTIVE
Measurement of N-terminal pro-B-type natriuretic peptide (NTproBNP) helps in diagnosing heart failure (HF). The test's usefulness may be greatest in patients with severe dyspnea of uncertain origin. However, NTproBNP has not been evaluated specifically in this setting.


METHODS
This prospective emergency department study included 70 patients with shortness of breath at rest as their chief complaint. In the attending physician's opinion, both HF and a non-cardiac cause were equally probable. Blinded NTproBNP measurement was carried out in blood samples collected on admission. Patients were monitored and their final diagnoses were based on clinical findings, therapeutic responses, and cardiac and noncardiac tests performed during hospitalization.


RESULTS
The NTproBNP level was higher in the 49 patients (70%) with a final diagnosis of HF (P = .006); the area under the ROC curve was 0.72 (0.60-0.82). The optimum diagnostic cut-off value was 900 pg/mL, which had an accuracy of 87%, a sensitivity of 98%, and a negative predictive value of 92%. The NTproBNP level was significantly higher in the 6 patients (9%) who died during hospitalization (P = .009); the area under the ROC curve was 0.87 (0.76-0.93) and the optimum cut-off value for predicting death was 5500 pg/mL, which had an accuracy of 77%, a sensitivity of 100%, and a positive likelihood ratio of 4.2.


CONCLUSIONS
In patients with severe dyspnea and an uncertain diagnosis of HF, an NTproBNP level < 900 pg/mL helps exclude the presence of HF, whereas a NTproBNP level > 5500 pg/mL identifies patients at an increased risk of death.
Pascual Figal
Domingo A
DA
Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. dapascual@servicam.com
Cerdán Sánchez
María C
MC
Noguera Velasco
José A
JA
Casas Pina
Teresa
T
Muñoz Gimeno
Luis
L
García Rodríguez
Rosa
R
Ruipérez Abizanda
Juan A
JA
Martínez Hernández
Pedro
P
Valdés Chávarri
Mariano
M
D000368:Aged; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D004638:Emergency Treatment; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D020097:Natriuretic Peptide, Brain