Document Detail


Natriuretic peptides and echocardiography in acute dyspnoea: implication of elevated levels with normal systolic function.
MedLine Citation:
PMID:  19515720     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Previous evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.
METHODS AND RESULTS: Prospective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37% of patients and 13% died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF <or= 40% was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF >or= 50%. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF >or= 50%.
CONCLUSION: In an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.
Authors:
Keyur B Shah; Willem J Kop; Robert H Christenson; Deborah B Diercks; Dick Kuo; Sue Henderson; Karen Hanson; Shu-Ying Li; Christopher R deFilippi
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-06-10
Journal Detail:
Title:  European journal of heart failure     Volume:  11     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-25     Completed Date:  2010-09-21     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  659-67     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, The University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Biological Markers / blood
Blood Pressure / physiology
Cohort Studies
Diastole
Dyspnea / blood*,  ultrasonography
Emergency Service, Hospital
Female
Heart Failure / blood*,  diagnosis,  ultrasonography
Humans
Male
Middle Aged
Multivariate Analysis
Natriuretic Peptide, Brain / blood*
Peptide Fragments / blood*
Prospective Studies
ROC Curve
Statistics, Nonparametric
Systole
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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