Circulation. 2002;106:416-422
Published online before print July 1, 2002, doi: 10.1161/01.CIR.0000025242.79963.4C
Published online before print July 1, 2002, doi: 10.1161/01.CIR.0000025242.79963.4C
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(Circulation. 2002;106:416.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
B-Type Natriuretic Peptide and Clinical Judgment in Emergency Diagnosis of Heart Failure
Analysis From Breathing Not Properly (BNP) Multinational Study
From the University of California (P.C., P.K., R.K., A.S.M.), Veteran’s Affairs Medical Center, San Diego; Henry Ford Hospital (R.M.N., J.M.), Detroit, Mich; University of Pennsylvania (J.E.H., H.C.H.), Philadelphia; Hopital Bichat (P.G.S., P.D.), Paris, France; Ullevål University Hospital (A.W., T.O., C.W.K.), Oslo, Norway; University of Cincinnati College of Medicine (A.B.S.), Cincinnati, Ohio; University of Kentucky College of Medicine (W.T.A., S.L.), Lexington; Hartford Hospital (A.H.B.W., A.P.), Hartford, Conn; and University of Missouri–Kansas City School of Medicine (P.A.M.), Truman Medical Center, Kansas City, Mo.
Correspondence to Peter A. McCullough, MD, MPH, University of Missouri–Kansas City School of Medicine, Truman Medical Centers, 2301 Holmes St, Kansas City, MO 64108. E-mail mcculloughp{at}umkc.edu
Background— We sought to determine the degree to which B-type natriuretic peptide (BNP) adds to clinical judgment in the diagnosis of congestive heart failure (CHF).
Methods and Results— The Breathing Not Properly Multinational Study was a prospective diagnostic test evaluation study conducted in 7 centers. Of 1586 participants who presented with acute dyspnea, 1538 (97%) had clinical certainty of CHF determined by the attending physician in the emergency department. Participants underwent routine care and had BNP measured in a blinded fashion. The reference standard for CHF was adjudicated by 2 independent cardiologists, also blinded to BNP results. The final diagnosis was CHF in 722 (47%) participants. At an 80% cutoff level of certainty of CHF, clinical judgment had a sensitivity of 49% and specificity of 96%. At 100 pg/mL, BNP had a sensitivity of 90% and specificity of 73%. In determining the correct diagnosis (CHF versus no CHF), adding BNP to clinical judgment would have enhanced diagnostic accuracy from 74% to 81%. In those participants with an intermediate (21% to 79%) probability of CHF, BNP at a cutoff of 100 pg/mL correctly classified 74% of the cases. The areas under the receiver operating characteristic curve were 0.86 (95% CI 0.84 to 0.88), 0.90 (95% CI 0.88 to 0.91), and 0.93 (95% CI 0.92 to 0.94) for clinical judgment, for BNP at a cutoff of 100 pg/mL, and for the 2 in combination, respectively (P<0.0001 for all pairwise comparisons).
Conclusions— The evaluation of acute dyspnea would be improved with the addition of BNP testing to clinical judgment in the emergency department.
Key Words: heart failure • diagnosis • natriuretic peptides • lung • tests
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