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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

Cathrine Wold Knudsen, MD^_*, Torbjørn Omland, MD, PhD, MPH^,_*, Paul Clopton, MSc, Arne Westheim, MD, PhD^_*, Alan H.B. Wu, PhD, Philippe Duc, MD^||, James McCord, MD^¶, Richard M. Nowak, MD, MBA^¶, Judd E. Hollander, MD^#, Alan B. Storrow, MD^**, William T. Abraham, MD, FACC, Peter A. McCullough, MD and Alan Maisel, MD, FACC

^_* Ullevål University Hospital, Oslo, Norway
Akershus University Hospital, University of Oslo, Oslo, Norway
University of California, San Diego, Veterans Affairs Medical Center, San Diego, California
University of California, San Francisco, San Francisco General Hospital, San Francisco, California ||Hopital Bichat, Paris, France
^¶ Henry Ford Hospital, Detroit, Michigan
^# University of Pennsylvania, Philadelphia, Pennsylvania
^** University of Cincinnati College of Medicine, Cincinnati, Ohio
University of Kentucky College of Medicine, Lexington, Kentucky
William Beaumont Hospital, Royal Oak, Michigan

View larger version (22K): [in a new window]   Figure 1 B-type natriuretic peptide (BNP) levels in patients with and without atrial fibrillation and with and without a final diagnosis of acute heart failure. In patients without heart failure, BNP levels were significantly higher in patients with atrial fibrillation than in those without (p < 0.001). In patients with heart failure, BNP levels were not significantly different between patients with and without atrial fibrillation. B-type natriuretic peptide levels are plotted on a log scale. The boxes represent the 25th, 50th, and 75th percentiles, and the whiskers indicate the 10th and 90th percentiles.

View larger version (25K): [in a new window]   Figure 2 Receiver-operating characteristic curve for various cutoff levels of B-type natriuretic peptide in differentiating between dyspnea due to acute heart failure and dyspnea due to other causes in patients with and without atrial fibrillation. The area under the curve was 0.84 (95% confidence interval 0.78 to 0.89) and 0.91 (95% confidence interval 0.89 to 0.93) for those with and without atrial fibrillation, respectively.

View larger version (17K): [in a new window]   Figure 3 B-type natriuretic peptide levels in patients with atrial fibrillation on the electrocardiogram (ECG) on admission (n = 158), and in patients with a medical history of atrial fibrillation but sinus rhythm on the ECG on admission (n = 134) (p = 0.189). B-type natriuretic peptide (BNP) levels are plotted on a log scale. The boxes represent the 25th, 50th, and 75th percentiles, and the whiskers indicate the 10th and 90th percentiles.