Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study.

Authors

Alan S Maisel
James McCord
Richard M Nowak
Judd E Hollander
Alan H B Wu
Philippe Duc
Torbjørn Omland
Alan B Storrow
Padma Krishnaswamy
William T Abraham
Paul Clopton
Gabriel Steg
Marie Claude Aumont
Arne Westheim
Cathrine Wold Knudsen
Alberto Perez
Richard Kamin
Radmila Kazanegra
Howard C Herrmann
Peter A McCullough

Publication/Presentation Date

6-4-2003

Abstract

OBJECTIVES: This study examines B-type natriuretic peptide (BNP) levels in patients with systolic versus non-systolic dysfunction presenting with shortness of breath.

BACKGROUND: Preserved systolic function is increasingly common in patients presenting with symptoms of congestive heart failure (CHF) but is still difficult to diagnose.

METHODS: The Breathing Not Properly Multinational Study was a seven-center, prospective study of 1,586 patients who presented with acute dyspnea and had BNP measured upon arrival. A subset of 452 patients with a final adjudicated diagnosis of CHF who underwent echocardiography within 30 days of their visit to the emergency department (ED) were evaluated. An ejection fraction of greater than 45% was defined as non-systolic CHF.

RESULTS: Of the 452 patients with a final diagnosis of CHF, 165 (36.5%) had preserved left ventricular function on echocardiography, whereas 287 (63.5%) had systolic dysfunction. Patients with non-systolic heart failure (NS-CHF) had significantly lower BNP levels than those with systolic heart failure (S-CHF) (413 pg/ml vs. 821 pg/ml, p < 0.001). As the severity of heart failure worsened by New York Heart Association class, the percentage of S-CHF increased, whereas the percentage of NS-CHF decreased. When patients with NS-CHF were compared with patients without CHF (n = 770), a BNP value of 100 pg/ml had a sensitivity of 86%, a negative predictive value of 96%, and an accuracy of 75% for detecting abnormal diastolic dysfunction. Using Logistic regression to differentiate S-CHF from NS-CHF, BNP entered first as the strongest predictor followed by oxygen saturation, history of myocardial infarction, and heart rate.

CONCLUSIONS: We conclude that NS-CHF is common in the setting of the ED and that differentiating NS-CHF from S-CHF is difficult in this setting using traditional parameters. Whereas BNP add modest discriminatory value in differentiating NS-CHF from S-CHF, its major role is still the separation of patients with CHF from those without CHF.

Volume

41

Issue

11

First Page

2010

Last Page

2017

ISSN

0735-1097

Published In/Presented At

Maisel, A. S., McCord, J., Nowak, R. M., Hollander, J. E., Wu, A. H., Duc, P., Omland, T., Storrow, A. B., Krishnaswamy, P., Abraham, W. T., Clopton, P., Steg, G., Aumont, M. C., Westheim, A., Knudsen, C. W., Perez, A., Kamin, R., Kazanegra, R., Herrmann, H. C., McCullough, P. A., … Breathing Not Properly Multinational Study Investigators (2003). Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. Journal of the American College of Cardiology, 41(11), 2010–2017. https://doi.org/10.1016/s0735-1097(03)00405-4

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

12798574

Department(s)

Administration and Leadership

Document Type

Article