title: NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy.
abstract: OBJECTIVE
  The objective of this study was to determine the integrative utility of measuring plasma NT-proBNP levels with echocardiography in the evaluation of dyspnoeic patients.
  
  
  RESULTS
  Of 599 emergency department patients enrolled in a clinical study of NT-proBNP at a tertiary-care hospital, 134 (22%) had echocardiographic results available for analysis. Echocardiographic parameters correlating with NT-proBNP levels were determined using multivariable linear-regression analysis. Independent predictors of 1-year mortality were determined using Cox-proportional hazard analysis. Independent relationships were found between NT-proBNP levels and ejection fraction (P = 0.012), tissue Doppler early and late mitral annular diastolic velocities (P = 0.007 and 0.018), right ventricular (RV) hypokinesis (P = 0.006), and tricuspid regurgitation severity (P < 0.001) and velocity (P = 0.007). An NT-proBNP level <300 pg/mL had a negative predictive value of 91% for significant left ventricular systolic and diastolic dysfunction. Overall 1-year mortality was 20.1% and was independently predicted by NT-proBNP level [HR 8.65, 95% confidence interval (CI) 2.7-27.8, P = 0.0003], ejection fraction (HR 0.95, 95% CI 0.91-0.99, P = 0.009), RV dilation (HR 2.98, 95% CI 1.05-12.8, P = 0.04), and systolic blood pressure (HR 0.97, 95% CI 0.96-0.99, P = 0.01).
  
  
  CONCLUSIONS
  NT-proBNP levels correlate with, and provide important prognostic information beyond, echocardiographic parameters of cardiac structure and function. Routine NT-proBNP testing may thus be useful to triage patients to more timely or deferred echocardiographic evaluation.
authors.affiliation: Division of Cardiology, Cardiac Ultrasound Laboratory, and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, USA.
authors.forename: Annabel A
authors.initials: AA
authors.lastname: Chen
authors.forename: Malissa J
authors.initials: MJ
authors.lastname: Wood
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Krauser
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D004417:Dyspnea / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain