title: NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.
abstract: OBJECTIVE
  Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents.
  
  
  RESULTS
  Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P<0.001), and levels of NT-proBNP correlated with HF symptom severity (P=0.008). An optimal strategy to identify acute HF was to use age-related cut-points of 450, 900, and 1800 pg/mL for ages <50, 50-75, and >75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2-8.1, P<0.001].
  
  
  CONCLUSIONS
  In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA 02114, USA. jjanuzzi@partners.org
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Roland
authors.initials: R
authors.lastname: van Kimmenade
authors.forename: John
authors.initials: J
authors.lastname: Lainchbury
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordonez-Llanos
authors.forename: Miguel
authors.initials: M
authors.lastname: Santalo-Bel
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
mesh_terms: D000208:Acute Disease; D002986:Clinical Trials as Topic; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain