Value of brain natriuretic peptides in primary care patients with the clinical diagnosis of chronic heart failure.
BACKGROUND
Brain natriuretic peptide (BNP) and N-Terminal pro natriuretic peptide (NT-proBNP) are widely accepted to diagnose congestive heart failure (CHF) in the emergency room. The aim of this study was to evaluate the value of BNP and NT-proBNP to diagnose CHF in primary care.


METHODS
Clinical and Doppler-echocardiographic assessment of patients referred by their general practitioner (GP) with the diagnosis of CHF. Receiver operating curves were used to evaluate the accuracy of BNP and NT-proBNP for echocardiographically confirmed systolic and/or diastolic heart failure.


RESULTS
Three hundred and eighty four patients (mean age of 65) were included. One hundred and ninety three (50%) patients had systolic heart failure and 31 (8%) had isolated diastolic heart failure. Using currently recommended cut-off values of BNP (less than 100 pg/ml) and NT-proBNP (less than 125 pg/ml) for exclusion of CHF, BNP was false negative in 25% and NT-proBNP in 10% of the patients. The area under the curve was better for NT-proBNP than for BNP (0.742 vs. 0.691).


CONCLUSIONS
In this population with a high prevalence of CHF, BNP and NT-proBNP failed to adequately rule out CHF. GP's should be cautious when using BNP and NT-proBNP in primary care. An echocardiography remains compulsory in unexplained dyspnea.
Zuber
Michel
M
Department of Cardiology, Kantonsspital Luzern, Luzern, Switzerland.
Cuculi
Florim
F
Attenhofer Jost
Christine H
CH
Kipfer
Peter
P
Buser
Peter
P
Seifert
Burkhardt
B
Erne
Paul
P
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004417:Dyspnea / Q000097:blood / Q000209:etiology; D015150:Echocardiography, Doppler; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D054143:Heart Failure, Systolic / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011446:Prospective Studies; D012372:ROC Curve; D012017:Referral and Consultation; D013557:Switzerland; D016896:Treatment Outcome
D015415:Biomarkers; D002317:Cardiovascular Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain