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J Am Coll Cardiol, 2003; 42:728-735, doi:10.1016/S0735-1097(03)00787-3
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath

John G. Lainchbury, MD*,*, Elizabeth Campbell, BSc (Hons)*, Christopher M. Frampton, PhD*, Timothy G. Yandle, PhD*, M. Gary Nicholls, MD, FACC* and A. Mark Richards, MD, PhD*

* Department of Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand

Manuscript received February 4, 2003; revised manuscript received March 27, 2003, accepted May 12, 2003.

* Reprint requests and correspondence: Dr. John G. Lainchbury, Department of Medicine, Christchurch Hospital, Riccarton Avenue, P. O. Box 4345, Christchurch, New Zealand.
john.lainchbury{at}chmeds.ac.nz

OBJECTIVES: This study sought to compare the utility of measurement of plasma brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (N-BNP) in the diagnosis of heart failure (HF) in patients with acute dyspnea.

BACKGROUND: Plasma BNP is useful in differentiating HF from other causes of dyspnea in the emergency department. The N-terminal component of BNP has a longer half-life, and in HF increases in plasma N-BNP are proportionately greater.

METHODS: We studied 205 patients (average age 70 ± 14 years) presenting to the emergency department with acute dyspnea. Brain natriuretic peptide was analyzed using a point-of-care test and two locally developed radioimmunoassays. N-terminal BNP was measured using a locally developed radioimmunoassay and a commercially available assay. Final diagnosis of HF was adjudicated by two cardiologists.

RESULTS: Patients with HF (n = 70) had higher mean levels of both hormones by all assays (p < 0.001 for all). Results with all assays correlated closely (r values between 0.902 and 0.969). Subjects with left ventricular (LV) dysfunction or left-sided valvular disease but no HF had intermediate levels of BNP and N-BNP (lower than subjects with HF, and higher than subjects without HF with no LV dysfunction or left-sided valvular disease) (p < 0.01 for all). Using optimum cut-offs, specificity for the diagnosis of HF ranged between 70% and 89% (highest for the N-BNP assays). Sensitivity ranged between 80% and 94% (highest for the point-of-care BNP assay).

CONCLUSIONS: Measurement of BNP or N-BNP is useful in the diagnosis of HF in acute dyspnea. Commercially available assays compare favorably with well-validated laboratory assays. Differences in sensitivity and specificity may influence the assay choice in this setting.

Abbreviations and Acronyms
  BNP
  brain natriuretic peptide
  CNP
  C-type natriuretic peptide
  HF
  heart failure
  LV
  left ventricular
  N-BNP
  N-terminal brain natriuretic peptide




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