title: [Usefulness of NTproBNP in the emergency management of patients with severe dyspnea and an uncertain heart failure diagnosis].
abstract: 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.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. dapascual@servicam.com
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual Figal
authors.forename: María C
authors.initials: MC
authors.lastname: Cerdán Sánchez
authors.forename: José A
authors.initials: JA
authors.lastname: Noguera Velasco
authors.forename: Teresa
authors.initials: T
authors.lastname: Casas Pina
authors.forename: Luis
authors.initials: L
authors.lastname: Muñoz Gimeno
authors.forename: Rosa
authors.initials: R
authors.lastname: García Rodríguez
authors.forename: Juan A
authors.initials: JA
authors.lastname: Ruipérez Abizanda
authors.forename: Pedro
authors.initials: P
authors.lastname: Martínez Hernández
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés Chávarri
mesh_terms: 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
chemical_list: D020097:Natriuretic Peptide, Brain