Utility of NT-proBNP for identifying LV failure in patients with acute exacerbation of chronic bronchitis.
BACKGROUND
NT-proBNP has been widely regarded as a useful tool for diagnosis or exclusion of heart failure (HF) in many settings. However, in patients with acute exacerbation of chronic bronchitis (AECB), its roles have not been well described. The objective of this study was to evaluate the diagnostic performance of NT-proBNP for identifying left ventricular (LV) failure in such patients.


RESULTS
311 AECB patients and 102 stable chronic bronchitis patients with no history of HF were enrolled. Plasma NT-proBNP concentrations were measured using Roche Elecsys. The European Society of Cardiology (ESC) diagnostic principles were adopted to identify HF and the diagnostic performance of NT-proBNP was evaluated by ROC. Our results showed, the median NT-proBNP level in patients with LV failure [4828.4 (2044.4-9203.6) ng/L] was significantly higher than that in those without LV failure [519.2 (179.1-1409.8) ng/L, p<0.001] and stable controls [207.5 (186.5-318.2) ng/L, p<0.001]. LV failure, renal function, atrial fibrillation and systolic pulmonary artery pressure were independent predictors of NT-proBNP levels (all p<0.05). The area under ROC curve (AUC) of NT-proBNP for identifying LV failure was 0.884, significantly superior to clinical judgment alone (AUC 0.835, p = 0.0294). At the optimal cutoff value of 935.0 ng/L, NT-proBNP yielded sensitivity 94.4%, specificity 68.2%, accuracy 74.3% and negative predictive value 97.6%. Adding the results of NT-proBNP to those of clinical judgment improved the diagnostic accuracy for LV failure.


CONCLUSIONS
As a tool for diagnosis or exclusion of HF, NT-proBNP can help physicians identify LV failure in patients with AECB.
Department of Clinical Laboratory, The Fifth People's Hospital of Wuxi, Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, PR China.
Qing-ping
QP
Wang
Xiao-zhi
XZ
Cao
Xue-dong
XD
Wang
Juan
J
Gu
Li-min
LM
Wen
Li-ming
LM
Mao
Ping-nan
PN
Shan
Ai-guo
AG
Tang
D000368:Aged; D000369:Aged, 80 and over; D029481:Bronchitis, Chronic / Q000097:blood / Q000150:complications*; D002138:Calibration; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012372:ROC Curve; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000150:complications / Q000175:diagnosis*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain