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J Am Coll Cardiol, 2001; 37:379-385 © 2001 by the American College of Cardiology Foundation |
* Division of Cardiology and General Internal Medicine and the Departments of Medicine and Nursing, Veteran’s Affairs Medical Center, San Diego, California, USA
University of California, San Diego, California, USA
Manuscript received June 14, 2000; revised manuscript received September 20, 2000, accepted October 26, 2000.
Reprint requests and correspondence: Dr. Alan Maisel, VAMC Cardiology 111-A, 3350 La Jolla Village Drive, San Diego, California 92161
amaisel{at}ucsd.edu
OBJECTIVES
The goal of this study was to evaluate the utility of a rapid "bedside" technique for measurement of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in an urgent-care setting.
BACKGROUND
B-type natriuretic peptide is a protein secreted from the cardiac ventricles in response to pressure overload. One potential application of measurements of BNP in blood is distinguishing dyspnea due to CHF from other causes.
METHODS
B-type natriuretic peptide concentrations were measured in a convenience sample of 250 predominantly male (94%) patients presenting to urgent-care and emergency departments of an academic Veteran’s Affairs hospital with dyspnea. Results were withheld from clinicians. Two cardiologists retrospectively reviewed clinical data (blinded to BNP measurements) and reached a consensus opinion on the cause of the patient’s symptoms. This gold standard was used to evaluate the diagnostic performance of the BNP test.
RESULTS
The mean BNP concentration in the blood of patients with CHF (n = 97) was higher than it was in patients without (1,076 ± 138 pg/ml vs. 38 ± 4 pg/ml, p < 0.001). At a blood concentration of 80 pg/ml, BNP was an accurate predictor of the presence of CHF (95%); measurements less than this had a high negative predictive value (98%). The overall C-statistic was 0.97. In multivariate analysis, BNP measurements added significant, independent explanatory power to other clinical variables in models predicting which patients had CHF. The availability of BNP measurements could have potentially corrected 29 of the 30 diagnoses missed by urgent-care physicians.
CONCLUSIONS
B-type natriuretic peptide blood concentration measurement appears to be a sensitive and specific test to diagnose CHF in urgent-care settings.
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