Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 71, Issue 11, Pages 1191-1200Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.01.021
Keywords
acute heart failure; biomarker; diagnosis; NT-proBNP; prognosis
Categories
Funding
- Roche Diagnostics, Inc.
- Hutter Family Professorship
- Abbott
- Cleveland Heart Labs
- Siemens
- Singulex
- Prevencio
- Roche Diagnostics
- Siemens Healthcare Diagnostics
- Beckman Coulter
- Spingotech
- Ortho Clinical Diagnostics
- Patient-Centered Outcomes Research Institute
- National Institutes of Health
- Alere
- Roche
- Portola
- Trinity
- National Heart, Lung, and Blood Institute
- National Institute on Minority Health and Health Disparities
- Amgen
- Bristol-Myers Squibb
- Novartis
- Trevena
- Edwards Lifesciences
- Cardiorentis
- Alere/Biosite
- Boehringer Ingelheim
- Thermo Fisher
- Nanosphere
- Radiometer
- American Heart Association
- Agency for Healthcare Research and Quality
- Banyan
- Janssen
- Pfizer
- Medicines Company
- ZS Pharma
- Clark Fund for Cardiac Research Innovation
- Ortho Clinical
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BACKGROUND Contemporary reconsideration of diagnostic N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. OBJECTIVES This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. METHODS Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (-) likelihood ratios (LRs) for acute HF. RESULTS Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR - was 0.09 (95% CI: 0.05 to 0.13). CONCLUSIONS In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP < 300 pg/ml strongly excludes the presence of acute HF. (c) 2018 by the American College of Cardiology Foundation.
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