title: Brain natriuretic peptide usefulness in very elderly dyspnoeic patients: the BED study.
abstract: To evaluate the interest of brain natriuretic peptide (BNP) for heart failure (HF) diagnosis in very old patients.
  
  
  
  A total of 383 patients aged 80 years or older, hospitalized in geriatrics care for dyspnoea, had a BNP measurement at the acute phase. Independent cardiologists blinded to BNP values classified the patients into cardiac vs. respiratory aetiology according to the European Society of Cardiology guidelines. Mean (SD) age was 88.5 (5.4) years, 66% (n = 254) of patients were women, 62% (n = 238) had cardiac dyspnoea and 38% (n = 145) had respiratory dyspnoea. The BNP levels were significantly higher in the cardiac group (median = 385.5 ng/L, interquartile range = 174.0-842.0) than in the respiratory group (median = 172.0 ng/L, interquartile range = 70.8-428.0; P < 0.001). On its own, BNP showed poor discriminative ability [area under the curve (AUC) = 0.68; 95% confidence interval (CI) 0.62-0.73] for the diagnostic. In multivariate analysis, BNP remained independently associated with the cardiac aetiology after full-adjustment (odds ratio 1 log increase = 1.87; 95% CI 1.28-2.74), but did not improve the discrimination between the cardiac and the respiratory aetiologies (ΔAUC = 0.013, P = 0.16). In addition, although adding BNP to the other predictive covariates yielded a significant continuous NRI of 57.8% (95% CI 31.2-83.5%), the mean changes in individual predicted probabilities were too low (<3%) to be clinically relevant.
  
  
  
  In this population of very old patients with acute dyspnoea, despite being independently associated with the cardiac aetiology, BNP was not useful for better discriminating cardiac vs. respiratory origin.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.|Inserm, UMR-S970, Paris Cardiovascular Research Centre, PARCC, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Plichart
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Galdric
authors.initials: G
authors.lastname: Orvoën
authors.affiliation: René Dubos Hospital, Cardiology Department, Pontoise, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
authors.affiliation: Assistance Publique - Hôpitaux de Paris, Hôtel Dieu Hospital, Epidemiology and Biostatistics Unit, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Quinquis
authors.affiliation: Assistance Publique - Hôpitaux de Paris, Hôtel Dieu Hospital, Epidemiology and Biostatistics Unit, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.affiliation: Clinique Vert Coteau, Cardiology Department, Marseille, France.
authors.forename: Michele
authors.initials: M
authors.lastname: Escande
authors.affiliation: Blois Hospital, Department of Cardiology, Blois, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Friocourt
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Chedhomme
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Labourée
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Boully
authors.affiliation: Department of Geriatrics, University Hospital of Nancy, INSERM U1116, University of Lorraine, France.
authors.forename: Athanase
authors.initials: A
authors.lastname: Benetos
authors.affiliation: Geriatric Hospital 'Les Sources', Nice, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Domerego
authors.affiliation: Department of Cardiology, Pitié-Salpétrière Hospital, University Pierre et Marie Curie and IHU ICAN, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Broca Hospital, Paris, France.|EA 4468, Paris Cardiovascular Research Centre, PARCC, Paris, France.|University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D012140:Respiratory Tract Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Brain natriuretic peptide; Diagnosis; Discrimination; Dyspnoea; Elderly; Heart failure