B-Type Natriuretic Peptide and Clinical Judgment in Emergency Diagnosis of Heart Failure
Top Cited Papers
- 23 July 2002
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 106 (4), 416-422
- https://doi.org/10.1161/01.cir.0000025242.79963.4c
Abstract
Background — We sought to determine the degree to which B-type natriuretic peptide (BNP) adds to clinical judgment in the diagnosis of congestive heart failure (CHF). Methods and Results — The Breathing Not Properly Multinational Study was a prospective diagnostic test evaluation study conducted in 7 centers. Of 1586 participants who presented with acute dyspnea, 1538 (97%) had clinical certainty of CHF determined by the attending physician in the emergency department. Participants underwent routine care and had BNP measured in a blinded fashion. The reference standard for CHF was adjudicated by 2 independent cardiologists, also blinded to BNP results. The final diagnosis was CHF in 722 (47%) participants. At an 80% cutoff level of certainty of CHF, clinical judgment had a sensitivity of 49% and specificity of 96%. At 100 pg/mL, BNP had a sensitivity of 90% and specificity of 73%. In determining the correct diagnosis (CHF versus no CHF), adding BNP to clinical judgment would have enhanced diagnostic accuracy from 74% to 81%. In those participants with an intermediate (21% to 79%) probability of CHF, BNP at a cutoff of 100 pg/mL correctly classified 74% of the cases. The areas under the receiver operating characteristic curve were 0.86 (95% CI 0.84 to 0.88), 0.90 (95% CI 0.88 to 0.91), and 0.93 (95% CI 0.92 to 0.94) for clinical judgment, for BNP at a cutoff of 100 pg/mL, and for the 2 in combination, respectively ( P Conclusions — The evaluation of acute dyspnea would be improved with the addition of BNP testing to clinical judgment in the emergency department.This publication has 20 references indexed in Scilit:
- The Prognostic Value of B-Type Natriuretic Peptide in Patients with Acute Coronary SyndromesThe New England Journal of Medicine, 2001
- Guidelines for the diagnosis and treatment of chronic heart failureEuropean Heart Journal, 2001
- Twenty year trends (1975–1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: A community-wide perspectiveJournal of the American College of Cardiology, 1999
- Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL studyJournal of the American College of Cardiology, 1999
- Biochemical detection of left-ventricular systolic dysfunctionThe Lancet, 1998
- Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy. Evidence for brain natriuretic peptide as an "emergency" cardiac hormone against ventricular overload.JCI Insight, 1995
- The epidemiology of heart failure: The Framingham StudyJournal of the American College of Cardiology, 1993
- Cloning and sequence analysis of cDNA encoding a precursor for human brain natriuretic peptideBiochemical and Biophysical Research Communications, 1989
- Cloning and sequence analysis of cDNA encoding a precursor for rat brain natriuretic peptideBiochemical and Biophysical Research Communications, 1989
- Pathophysiology of congestive heart failureThe American Journal of Cardiology, 1985