Diagnostic value of pleural fluid N-terminal pro-brain natriuretic peptide levels in patients with cardiovascular diseases.
OBJECTIVE
The diagnosis of the cause of pleural effusions caused by cardiovascular diseases such as congestive heart failure (CHF) and acute pulmonary embolism is sometimes difficult. The purpose of the present study was to evaluate the utility of pleural fluid levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in differentiating pleural effusions due to CHF, pulmonary embolism and post-coronary artery bypass graft (CABG) surgery.


METHODS
The levels of pleural fluid NT-proBNP were measured by ELISA in a total of 40 patients: 10 with CHF, 10 with pulmonary embolism, 10 post-CABG and 10 with carcinoma.


RESULTS
The median level of NT-proBNP in the pleural fluid of patients with CHF was 5390 pg/mL (25th to 75th percentiles, 4566 to 8158 pg/mL), which was significantly higher than that in patients with post-CABG effusions (424 pg/mL, 352 to 873), with pulmonary embolism (311 pg/mL, 212 to 1159), or with carcinoma (302 pg/mL, 208 to 626) (P < 0.001, CHF group vs all other groups). In receiver-operating curve analysis, an NT-proBNP level of >or=2220 pg/mL demonstrated a sensitivity of 100% and a specificity of 96.7% for the identification of CHF.


CONCLUSIONS
Measurement of the NT-proBNP level in pleural fluid is accurate in diagnosing the etiology of the effusion as CHF. Pleural fluid levels above 2220 pg/mL are essentially diagnostic that the pleural effusion is due to CHF.
Liao
Huai
H
Department of Pulmonary Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. liaohuai1208@hotmail.com
Na
Moon Jun
MJ
Dikensoy
Oner
O
Lane
Kirk B
KB
Randal
Barnette
B
Light
Richard W
RW
D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D001026:Coronary Artery Bypass; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D010996:Pleural Effusion / Q000209:etiology* / Q000378:metabolism*; D010997:Pleural Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000378:metabolism
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain