Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 42, Issue 4, Pages 728-735Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0735-1097(03)00787-3
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OBJECTIVES This study sought to compare the utility of measurement of plasma brain natriuretic peptide (BHP) and N-terminal brain natriuretic peptide (N-BHP) 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. (C) 2003 by the American College of Cardiology Foundation.
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