HEART FAILURE
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
Manuscript received March 1, 2005;
accepted May 9, 2005.
* Reprint requests and correspondence: Dr. Torbjørn Omland, Department of Medicine, Akershus University Hospital, University of Oslo, N-1474 Nordbyhagen, Norway
(Email: torbjorn.omland{at}medisin.uio.no).
OBJECTIVES: This study was designed to assess the diagnostic performance of B-type natriuretic peptide (BNP) in the diagnosis of acute congestive heart failure (CHF) in patients with permanent/paroxysmal atrial fibrillation (AF) presenting with acute dyspnea.
BACKGROUND: It is unknown to what extent AF affects the diagnostic performance of BNP in patients presenting with acute dyspnea.
METHODS: We studied 1,431 patients drawn from a cohort of patients (n = 1,586) with acute dyspnea who had BNP levels measured on arrival. Patients were prospectively classified according to the presence or absence of permanent/paroxysmal AF.
RESULTS: In total, 292 patients had permanent/paroxysmal AF. In patients without HF, permanent/paroxysmal AF was associated with significantly higher BNP levels (p = 0.001). Conversely, in patients with HF, BNP levels did not differ significantly between patients with and without AF (p = 0.533). A BNP cutoff value of 100 pg/ml had a specificity of 40% and 79% for the diagnosis of acute HF in patients with and without AF, respectively. The areas under the receiver-operating characteristic curves were 0.84 (95% confidence interval 0.78 to 0.89) and 0.91 (95% confidence interval 0.89 to 0.93) for patients with and without AF, respectively.
CONCLUSIONS: In patients without, but not in those with HF, the presence of AF is associated with higher circulating BNP levels, suggesting that a higher diagnostic threshold should be used in patients with AF.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | BNP = B-type natriuretic peptide | | CHF = congestive heart failure | | ECG = electrocardiogram/electrocardiographic | | ED = emergency department | | HF = heart failure | | ROC = receiver-operating characteristic |
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