Superior performance of N-terminal pro brain natriuretic peptide for diagnosis of acute decompensated heart failure in an Asian compared with a Western setting.
This study was conducted to test the diagnostic performance of NT-proBNP for discrimination of acute decompensated heart failure (ADHF) among breathless patients presenting in an Asian compared with a Western centre.



Patients with breathlessness were prospectively and contemporaneously recruited in Emergency Departments in Singapore and New Zealand (NZ). The diagnosis of ADHF was adjudicated by two clinician specialists. A total of 606 patients were recruited in Singapore and 500 in NZ. The discriminative power of NT-proBNP for ADHF was superior in Singapore compared with NZ [area under the curve (AUC) 0.926 vs. 0.866; P = 0.012] both overall and among selected subgroups stratified according to age, renal function, body mass index, and presence or absence of AF or diabetes. Previously established cut-off point values of plasma NT-proBNP yielded comparable sensitivity and negative predictive values, but superior specificity and accuracy in Singapore compared with NZ. The difference in test performance was driven by the younger age (median age 56 years vs. 73 years; P < 0.001), associated with better renal function (estimated glomerular filtration rate 89 vs. 62 mL/min/1.73 m2; P < 0.001), and lower prevalence of AF (9.7% vs. 25.7%; P < 0.001) in acutely breathless patients in Singapore.



Considering emerging evidence of a lower average age of presentation with ADHF over most of Asia compared with Western countries, NT-proBNP is likely to be more accurate when applied in Asian centres than in the West.
Emergency Medicine Department, National University Hospital, National University Health System, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Irwani
I
Ibrahim
Emergency Medicine Department, National University Hospital, National University Health System, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Win Sen
WS
Kuan
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Chris
C
Frampton
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Richard
R
Troughton
Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Oi Wah
OW
Liew
Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Jenny Pek Ching
JP
Chong
Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Siew Pang
SP
Chan
Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Li Ling
LL
Tan
Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Wei Qin
WQ
Lin
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Chris J
CJ
Pemberton
Emergency Medicine Department, National University Hospital, National University Health System, Singapore.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Shirley Beng Suat
SB
Ooi
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.|Cardiovascular Research Institute, National University Heart Centre Singapore, National University Health System, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
A Mark
AM
Richards
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009520:New Zealand; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012846:Singapore; D044465:White People
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
Acute heart failure; Asia; Biomarkers; NT-proBNP; Western