|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2002; 39:202-209 © 2002 by the American College of Cardiology Foundation |
* Division of Cardiology, Veteran’s Affairs Medical Center, and the Department of Medicine, University of California, San Diego, California, USA
Manuscript received June 18, 2001; revised manuscript received October 4, 2001, accepted October 26, 2001.
* Reprint requests and correspondence: Dr. Alan Maisel, Veterans Affairs Medical Center, Cardiology 111-A, 3350 La Jolla Village Drive, San Diego, California 92161, USA.
amaisel{at}ucsd.edu
OBJECTIVES: Since B-type natriuretic peptide (BNP) is secreted by the left ventricle (LV) in response to volume elevated LV pressure, we sought to assess whether a rapid assay for BNP levels could differentiate cardiac from pulmonary causes of dyspnea.
BACKGROUND: Differentiating congestive heart failure (CHF) from pulmonary causes of dyspnea is very important for patients presenting to the emergency department (ED) with acute dyspnea.
METHODS: B-natriuretic peptide levels were obtained in 321 patients presenting to the ED with acute dyspnea. Physicians were blinded to BNP levels and asked to give their probability of the patient having CHF and their final diagnosis. Two independent cardiologists were blinded to BNP levels and asked to review the data and evaluate which patients presented with heart failure. Patients with right heart failure from cor pulmonale were classified as having CHF.
RESULTS: Patients with CHF (n = 134) had BNP levels of 758.5 ± 798 pg/ml, significantly higher than the group of patients with a final diagnosis of pulmonary disease (n = 85) whose BNP was 61 ± 10 pg/ml. The area under the receiver operating curve, which plots sensitivity versus specificity for BNP levels in separating cardiac from pulmonary disease, was 0.96 (p < 0.001). A breakdown of patients with pulmonary disease revealed: chronic obstructive pulmonary disease (COPD): 54 ± 71 pg/ml (n = 42); asthma: 27 ± 40 pg/ml (n = 11); acute bronchitis: 44 ± 112 pg/ml (n = 14); pneumonia: 55 ± 76 pg/ml (n = 8); tuberculosis: 93 ± 54 pg/ml (n = 2); lung cancer: 120 ± 120 pg/ml (n = 4); and acute pulmonary embolism: 207 ± 272 pg/ml (n = 3). In patients with a history of lung disease but whose current complaint of dyspnea was seen as due to CHF, BNP levels were 731 ± 764 pg/ml (n = 54). The group with a history of CHF but with a current COPD diagnosis had a BNP of 47 ± 23 pg/ml (n = 11).
CONCLUSIONS: Rapid testing of BNP in the ED should help differentiate pulmonary from cardiac etiologies of dyspnea.
| ||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  M. Nishii, T. Inomata, H. Takehana, T. Naruke, T. Yanagisawa, M. Moriguchi, S. Takeda, and T. Izumi Prognostic utility of B-type natriuretic peptide assessment in stable low-risk outpatients with nonischemic cardiomyopathy after decompensated heart failure. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2329 - 2335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. O. Maher, H. Reed, A. Cuadrado, J. Simsic, W. T. Mahle, M. DeGuzman, T. Leong, and S. Bandyopadhyay B-Type Natriuretic Peptide in the Emergency Diagnosis of Critical Heart Disease in Children Pediatrics, June 1, 2008; 121(6): e1484 - e1488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Daniels and A. S. Maisel Natriuretic Peptides J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2357 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mogelvang, J. P. Goetze, P. Schnohr, P. Lange, P. Sogaard, J. F. Rehfeld, and J. S. Jensen Discriminating Between Cardiac and Pulmonary Dysfunction in the General Population With Dyspnea by Plasma Pro-B-Type Natriuretic Peptide J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1694 - 1701. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Cortes, M. Rivera, A. Salvador, V. Bertomeu, F. G. de Burgos, E. Rosello-Lleti, M. Portoles, R. Paya, L. Martinez-Dolz, and V. Climent Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study Heart, August 1, 2007; 93(8): 957 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Pirracchio, B. Cholley, S. De Hert, A. C. Solal, and A. Mebazaa Diastolic heart failure in anaesthesia and critical care Br. J. Anaesth., June 1, 2007; 98(6): 707 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cannesson, C. Bionda, B. Gostoli, O. Raisky, S. di Filippo, D. Bompard, C. Vedrinne, R. Rousson, J. Ninet, J. Neidecker, et al. Time Course and Prognostic Value of Plasma B-type Natriuretic Peptide Concentration in Neonates Undergoing the Arterial Switch Operation Anesth. Analg., May 1, 2007; 104(5): 1059 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. Sin, E. Wong, I. Mayers, D. C. Lien, D. Feeny, H. Cheung, W. Q. Gan, and S. F. P. Man Effects of Nocturnal Noninvasive Mechanical Ventilation on Heart Rate Variability of Patients With Advanced COPD Chest, January 1, 2007; 131(1): 156 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y.-M. Wang, C. W.-K. Lam, C.-M. Yu, M. Wang, I. H.-S. Chan, Y. Zhang, S.-F. Lui, and J. E. Sanderson N-Terminal Pro-Brain Natriuretic Peptide: An Independent Risk Predictor of Cardiovascular Congestion, Mortality, and Adverse Cardiovascular Outcomes in Chronic Peritoneal Dialysis Patients J. Am. Soc. Nephrol., January 1, 2007; 18(1): 321 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Ceconi and R. Ferrari One heart, two lungs together forever. Am. J. Respir. Crit. Care Med., November 1, 2006; 174(9): 962 - 963. [Full Text] [PDF]
|
|
|
|
|
|
A. G. Kaditis, E. I. Alexopoulos, F. Hatzi, E. Kostadima, M. Kiaffas, E. Zakynthinos, and K. Gourgoulianis Overnight change in brain natriuretic Peptide levels in children with sleep-disordered breathing. Chest, November 1, 2006; 130(5): 1377 - 1384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Jelic and T. H. Le Jemtel Diagnostic Usefulness of B-Type Natriuretic Peptide and Functional Consequences of Muscle Alterations in COPD and Chronic Heart Failure. Chest, October 1, 2006; 130(4): 1220 - 1230. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Dodge-Khatami, E. V. Buchel, W. Knirsch, A. Kadner, V. Rousson, H. H. Dave, U. Bauersfeld, and R. Pretre Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation. Ann. Thorac. Surg., September 1, 2006; 82(3): 983 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Aspromonte, V. Ceci, A. Chiera, C. Coletta, A. D'Eri, M. Feola, P. Giovinazzo, L. Milani, F. Noventa, A. B. Scardovi, et al. Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure Clin. Chem., September 1, 2006; 52(9): 1802 - 1808. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N Ambrosino and M Serradori Determining the cause of dyspnoea: linguistic and biological descriptors Chronic Respiratory Disease, July 1, 2006; 3(3): 117 - 122. [PDF]
|
|
|
|
 |
|
 M. F. Elnoamany and A. K. Abdelhameed Mitral annular motion as a surrogate for left ventricular function: Correlation with brain natriuretic peptide levels Eur J Echocardiogr, June 1, 2006; 7(3): 187 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Battaglia, D. Pewsner, P. Juni, M. Egger, H. C. Bucher, and L. M. Bachmann Accuracy of B-type natriuretic Peptide tests to exclude congestive heart failure: systematic review of test accuracy studies. Arch Intern Med, May 22, 2006; 166(10): 1073 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Body and C. Roberts Brain natriuretic peptide as a potential marker of acute coronary syndromes Emerg. Med. J., May 1, 2006; 23(5): 403 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. S. Wang, J. M. FitzGerald, M. Schulzer, E. Mak, and N. T. Ayas Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure? JAMA, October 19, 2005; 294(15): 1944 - 1956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Knudsen, T. Omland, P. Clopton, A. Westheim, A. H.B. Wu, P. Duc, J. McCord, R. M. Nowak, J. E. Hollander, A. B. Storrow, et al. Impact of Atrial Fibrillation on the Diagnostic Performance of B-Type Natriuretic Peptide Concentration in Dyspneic Patients: An Analysis From the Breathing Not Properly Multinational Study J. Am. Coll. Cardiol., September 6, 2005; 46(5): 838 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Steg, L. Joubin, J. McCord, W. T. Abraham, J. E. Hollander, T. Omland, F. Mentre, P. A. McCullough, A. S. Maisel, and for the Breathing Not Properly Multinational Study B-Type Natriuretic Peptide and Echocardiographic Determination of Ejection Fraction in the Diagnosis of Congestive Heart Failure in Patients With Acute Dyspnea Chest, July 1, 2005; 128(1): 21 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Jefic, J. W. Lee, D. Jefic, R. T. Savoy-Moore, and H. S. Rosman Utility of B-Type Natriuretic Peptide and N-terminal Pro B-Type Natriuretic Peptide in Evaluation of Respiratory Failure in Critically Ill Patients Chest, July 1, 2005; 128(1): 288 - 295. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Cohen, C. Springer, A. Avital, Z. Perles, A. J. J. T. Rein, Z. Argaman, and A. Nir Amino-Terminal Pro-Brain-Type Natriuretic Peptide: Heart or Lung Disease in Pediatric Respiratory Distress? Pediatrics, May 1, 2005; 115(5): 1347 - 1350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bassan, A. Potsch, A. Maisel, B. Tura, H. Villacorta, M. V. Nogueira, A. Campos, R. Gamarski, A. C. Masetto, and M. A. Moutinho B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation Eur. Heart J., February 1, 2005; 26(3): 234 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Silva, A. W. Chan, C. J. White, T. J. Collins, J. S. Jenkins, J. P. Reilly, and S. R. Ramee Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients With Renal Artery Stenosis Circulation, January 25, 2005; 111(3): 328 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Dokainish, M. Pillai, S. A. Murphy, P. M. DiBattiste, M. J. Schweiger, A. Lotfi, D. A. Morrow, C. P. Cannon, E. Braunwald, N. Lakkis, et al. Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease: A TACTICS-TIMI-18 substudy J. Am. Coll. Cardiol., January 4, 2005; 45(1): 19 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. McCord, B. J. Mundy, M. P. Hudson, A. S. Maisel, J. E. Hollander, W. T. Abraham, P. G. Steg, T. Omland, C. W. Knudsen, K. R. Sandberg, et al. Relationship Between Obesity and B-Type Natriuretic Peptide Levels Arch Intern Med, November 8, 2004; 164(20): 2247 - 2252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Yap, D. Mukerjee, P. M. Timms, H. Ashrafian, and J. G. Coghlan Natriuretic Peptides, Respiratory Disease, and the Right Heart Chest, October 1, 2004; 126(4): 1330 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Maisel, J. E. Hollander, D. Guss, P. McCullough, R. Nowak, G. Green, M. Saltzberg, S. R. Ellison, M. A. Bhalla, V. Bhalla, et al. Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT): A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1328 - 1333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kemperman, M. van den Berg, H. Kirkels, and N. de Jonge B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP in Patients with End-Stage Heart Failure Supported by a Left Ventricular Assist Device Clin. Chem., September 1, 2004; 50(9): 1670 - 1672. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Rodeheffer Measuring plasma B-type natriuretic peptide in heart failure: Good to go in 2004? J. Am. Coll. Cardiol., August 18, 2004; 44(4): 740 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hutfless, R. Kazanegra, M. Madani, M. A. Bhalla, A. Tulua-Tata, A. Chen, P. Clopton, C. James, A. Chiu, and A. S. Maisel Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1873 - 1879. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. B. Granger, J. E. Van Eyk, S. C. Mockrin, N. L. Anderson, and on behalf of the Working Group Members National Heart, Lung, and Blood Institute Clinical Proteomics Working Group Report Circulation, April 13, 2004; 109(14): 1697 - 1703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Heidenreich, M. A. Gubens, G. C. Fonarow, M. A. Konstam, L. W. Stevenson, and P. G. Shekelle Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1019 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. D. I. Anderson, F. Wang, and D. G. Gardner Role of the Epidermal Growth Factor Receptor in Signaling Strain-dependent Activation of the Brain Natriuretic Peptide Gene J. Biol. Chem., March 5, 2004; 279(10): 9287 - 9297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Penicka, J. Bartunek, B. De Bruyne, M. Vanderheyden, M. Goethals, M. De Zutter, P. Brugada, and P. Geelen Improvement of Left Ventricular Function After Cardiac Resynchronization Therapy Is Predicted by Tissue Doppler Imaging Echocardiography Circulation, March 2, 2004; 109(8): 978 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Maron, V. N. Tholakanahalli, A. G. Zenovich, S. A. Casey, D. Duprez, D. M. Aeppli, and J. N. Cohn Usefulness of B-Type Natriuretic Peptide Assay in the Assessment of Symptomatic State in Hypertrophic Cardiomyopathy Circulation, March 2, 2004; 109(8): 984 - 989. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Logeart, G. Thabut, P. Jourdain, C. Chavelas, P. Beyne, F. Beauvais, E. Bouvier, and A. C. Solal Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure J. Am. Coll. Cardiol., February 18, 2004; 43(4): 635 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Mueller, A. Scholer, K. Laule-Kilian, B. Martina, C. Schindler, P. Buser, M. Pfisterer, and A. P. Perruchoud Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea N. Engl. J. Med., February 12, 2004; 350(7): 647 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. de Denus, C. Pharand, and D. R. Williamson Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone Chest, February 1, 2004; 125(2): 652 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Prahash and T. Lynch B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure Am. J. Crit. Care., January 1, 2004; 13(1): 46 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Clerico and M. Emdin Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review Clin. Chem., January 1, 2004; 50(1): 33 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Senior, G Galasko, J V McMurray, and J Mayet Screening for left ventricular dysfunction in the community: role of hand held echocardiography and brain natriuretic peptides Heart, November 1, 2003; 89(90003): iii24 - 28. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Pruszczyk, M. Kostrubiec, A. Bochowicz, G. Styczynski, M. Szulc, M. Kurzyna, A. Fijalkowska, A. Kuch-Wocial, I. Chlewicka, and A. Torbicki N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism Eur. Respir. J., October 1, 2003; 22(4): 649 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Hryniewicz, A. S. Androne, A. Hudaihed, and S. D. Katz Comparative Effects of Carvedilol and Metoprolol on Regional Vascular Responses to Adrenergic Stimuli in Normal Subjects and Patients With Chronic Heart Failure Circulation, August 26, 2003; 108(8): 971 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A S Androne, K Hryniewicz, R Goldsmith, A Arwady, and S D Katz Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure Heart, August 1, 2003; 89(8): 854 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Cardarelli and T. G. Lumicao Jr B-type Natriuretic Peptide: A Review of Its Diagnostic, Prognostic, and Therapeutic Monitoring Value in Heart Failure for Primary Care Physicians J Am Board Fam Med, July 1, 2003; 16(4): 327 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Maisel, J. McCord, R. M. Nowak, J. E. Hollander, A. H. B. Wu, P. Duc, T. Omland, A. B. Storrow, P. Krishnaswamy, W. T. Abraham, et al. 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 J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2010 - 2017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ruskoaho Cardiac Hormones as Diagnostic Tools in Heart Failure Endocr. Rev., June 1, 2003; 24(3): 341 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Jessup and S. Brozena Heart Failure N. Engl. J. Med., May 15, 2003; 348(20): 2007 - 2018. [Full Text] [PDF]
|
|
|
|
|
|
R. Shabetai Monitoring heart failure hemodynamics with an implanted device:its potential to improve outcome J. Am. Coll. Cardiol., February 19, 2003; 41(4): 572 - 573. [Full Text] [PDF]
|
|
|
|
|
|
B. G. Angeja and W. Grossman Evaluation and Management of Diastolic Heart Failure Circulation, February 11, 2003; 107(5): 659 - 663. [Full Text] [PDF]
|
|
|
|
|
|
D. Logeart, C. Saudubray, P. Beyne, G. Thabut, P.-V. Ennezat, C. Chavelas, C. Zanker, E. Bouvier, and A. C. Solal Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1794 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. McCullough, R. M. Nowak, J. McCord, J. E. Hollander, H. C. Herrmann, P. G. Steg, P. Duc, A. Westheim, T. Omland, C. W. Knudsen, et al. B-Type Natriuretic Peptide and Clinical Judgment in Emergency Diagnosis of Heart Failure: Analysis From Breathing Not Properly (BNP) Multinational Study Circulation, July 23, 2002; 106(4): 416 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Maisel, P. Krishnaswamy, R. M. Nowak, J. McCord, J. E. Hollander, P. Duc, T. Omland, A. B. Storrow, W. T. Abraham, A. H.B. Wu, et al. Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure N. Engl. J. Med., July 18, 2002; 347(3): 161 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. I. Tulevski, B. J. M. Mulder, and D. J. van Veldhuisen Utility of a BNP as a marker for RV dysfunction in acute pulmonary embolism J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2080 - 2080. [Full Text] [PDF]
|
|
|
