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Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea

Damien Logeart, MD^*,*, Carole Saudubray, MD^*, Pascale Beyne, MD, Gabriel Thabut, MD, Pierre-Vladimir Ennezat, MD^*, Christophe Chavelas, MD^*, Caroline Zanker, MD, Erik Bouvier, MD^* and Alain Cohen Solal, MD, PhD^*

^* Service de Cardiologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
Service de Biochimie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
Service de Pneumologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
Service d’Accueil des Urgences, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France

View larger version (15K): [in a new window]   Figure 1 Box plots showing median levels of B-type natriuretic peptide (BNP) after logarithmic transformation. (A) Control groups (patients with chronic stable heart failure (HF); and patients with no HF or lung disease) and patients with acute dyspnea, according to the final diagnosis. *p < 0.001 between decompensated congestive left-heart failure (CHF) group and others groups. **p < 0.05 between non–HF group and "non–HF, non–lung disease" group. (B) Various subgroups of CHF and non–CHF patients, according to normal or abnormal left ventricular ejection fraction (LVEF). **p < 0.05.

View larger version (11K): [in a new window]   Figure 2 Receiver-operating characteristics curve for B-type natriuretic peptide cutoff values. AUC = area under the curve.

View larger version (18K): [in a new window]   Figure 3 Diagnostic value of B-type natriuretic peptide (BNP) and Doppler mitral pattern for decompensated congestive left-heart failure (CHF) in 43 patients with BNP levels between 80 and 300 pg/ml.

View larger version (22K): [in a new window]   Figure 4 Algorithm for the etiologic diagnosis of acute dyspnea, based on B-type natriuretic peptide (BNP) assay and Doppler echocardiography. CHF = decompensated congestive left-heart failure; ECG = electrocardiogram.