Document Detail

Gray zone BNP levels in heart failure patients in the emergency department: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study.
MedLine Citation:
PMID:  16644322     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The study purpose was to examine "gray zone" B-type natriuretic peptide (BNP) levels (100-500 pg/mL) in terms of associated clinical factors, perceived severity, and outcomes in patients with established congestive heart failure (CHF). BACKGROUND: Although gray zone BNP levels may have diagnostic ambiguity, the implications of these levels in patients with an established diagnosis of CHF have not been examined. METHODS: REDHOT was a national prospective study in which 464 patients seen in the emergency department with dyspnea had BNP levels drawn. Entrance criteria included a BNP > 100 pg/mL; however, physicians were blinded to the actual BNP level. Patients were followed up for 90 days. RESULTS: Thirty-three percent had gray zone BNP levels. There was no difference in perceived New York Heart Association class (P = .32) or admission rates (P = .76) between the gray zone and non-gray zone groups; 62% of patients with a gray zone BNP were identified as class III or IV CHF. Despite this perceived severity, the 90-day event rate was lower in the gray zone group (19.2% vs 32.9%, respectively, P = .002). Although patients in the gray zone had more symptoms of concomitant pulmonary disease, multivariate analysis could not demonstrate any variable that worsened the prognosis of patients with a gray zone BNP level. CONCLUSIONS: In patients with established CHF, those with gray zone BNP levels have a better prognosis than those with non-gray zone levels despite being perceived by physicians as having New York Heart Association class III or IV CHF.
Cynthia K Brenden; Judd E Hollander; David Guss; Peter A McCullough; Richard Nowak; Gary Green; Mitchell Saltzberg; Stefanie R Ellison; Meenakshi Awasthi Bhalla; Vikas Bhalla; Paul Clopton; Robert Jesse; Alan S Maisel;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  151     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-28     Completed Date:  2006-05-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1006-11     Citation Subset:  AIM; IM    
Hennepin County Medical Center, Minneapolis, MN, USA.
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MeSH Terms
Emergency Medical Services
Heart Failure / blood*,  complications,  mortality,  physiopathology
Hospitalization / statistics & numerical data
Lung Diseases / complications
Middle Aged
Natriuretic Peptide, Brain / blood*
Prospective Studies
ROC Curve
Severity of Illness Index
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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