Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older

Ray, Patrick; Arthaud, M; Birolleau, Sophie; Isnard, Richard; Lefort, Yannick; Boddaert, Jacques; Riou, Bruno

doi:10.1111/j.1532-5415.2005.53213.x

Cited by 72 publications

(55 citation statements)

References 39 publications

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“…BNP is an integrated marker of multiple aspects of cardiac dysfunction, including both myocardial stretch and ischaemia, and is clinically useful in identifying patients with acute cardiac failure [4,5]. Recent reports suggest that preoperative BNP levels may be a better prognostic test than dobutamine stress echocardiography for both 30-day [6] and long-term [7] major cardiac morbidity following vascular surgery.…”

mentioning

confidence: 99%

A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

Rodseth¹,

Padayachee²,

Biccard

2008

Anaesthesia

115

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SummaryWe conducted a meta-analysis of the utility of pre-operative B-type natriuretic peptide (BNP) and N-terminal-pro B-type natriuretic peptide in predicting early (< 30 days) and intermediate (< 180 days) term mortality and major adverse cardiac events (cardiac death and nonfatal myocardial infarction) in patients following vascular surgery. A Pubmed Central and EMBASE search was conducted up to January 2008. Of 81 studies identified, seven prospective observational studies were included in the meta-analysis representing five patient cohorts: early outcomes (504 patients) and intermediate-term outcomes (623 patients). A B-type natriuretic peptide or N-terminal-pro B-type natriuretic peptide above the optimal discriminatory threshold determined by receiver operating characteristic curve analysis was associated with 30-day cardiac death (OR 7.6, 95% CI 1.33-43.4, p = 0.02), nonfatal myocardial infarction (OR 6.24, 95% CI 1.82-21.4, p = 0.004) and major adverse cardiac events (OR 17.37, 95% CI 3.31-91.15, p = 0.0007), and intermediate-term, all-cause mortality (OR 3.1, 95% CI 1.85-5.2, p < 0.0001), nonfatal myocardial infarction (OR 2.95, 95% CI 1.17-7.46, p = 0.02) and major adverse cardiac events (OR 3.31, 95% CI 2.1-5.24, p < 0.00001). B-type natriuretic peptide and N-terminal-pro B-type natriuretic peptide are potentially useful pre-operative prognostic tests in vascular surgical patients. Vascular surgery is associated with major adverse perioperative cardiac events. Unfortunately, the currently used pre-operative diagnostic tests for these patients are not statistically robust enough to accurately predict these events [1]. This was recently confirmed in a meta-analysis of six pre-operative tests for vascular surgical patients, which included: ambulatory ECG, exercise ECG, radionuclide ventriculography, myocardial perfusion scintigraphy, dipyridamole stress echocardiography and dobutamine stress echocardiography [2]. Dobutamine stress echocardiography had a trend to the best performance of the six tests for the prediction of major adverse cardiac events (defined as peri-operative cardiac death and nonfatal myocardial infarction (MI)) within 30 days of surgery [2], with a positive likelihood ratio (LR) and negative LR of 2.8 and 0.21 respectively. As statistically good discrimination requires a LR of < 0.2 and > 10, there are clearly clinical limitations to the utility of these pre-operative tests for vascular surgical patients [1].There has been recent interest in brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) as prognostic biomarkers of death and major cardiovascular events, even after control for other cardiovascular risk factors [3]. BNP is an

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mentioning

confidence: 99%

A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

Rodseth¹,

Padayachee²,

Biccard

2008

Anaesthesia

115

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“…Renal dysfunction might at least partly explain the lower accuracy of NT-proBNP observed, because in contrast to BNP, renal excretion is a major route of elimination of NT-proBNP. 39 However, other studies which compared the diagnostic accuracy of BNP and NT-proBNP did not confi rm this fi nding. 32,51 In a subgroup (n = 75) analysis of their study, Berdague et …”

Section: Comparison Of Bnp and Nt-probnpmentioning

confidence: 38%

“…The ROC curve showed that BNP and NT-proBNP accurately diagnosed CHF, but the AUC for NTproBNP was lower than that of BNP (0.80 vs. 0.85, p Ͻ 0.05). 39 Using logistic regression, only the diagnosis of CHF predicted the elevation of BNP greater than 250 pg/mL (OR = 27.7, p Ͻ 0.001).…”

Section: Comparison Of Bnp and Nt-probnpmentioning

confidence: 99%

“…To our knowledge, few studies have specifi cally evaluated BNP and NT-proBNP in elderly patients 32,39,40,43,44 (Table 3). Ray et al demonstrated that increased BNP was the strongest independent predictor of a fi nal diagnosis of CHF (odds ratio 24.4, p Ͻ 0.001), and the accuracy of BNPassisted diagnosis was higher than that of the emergency physician (0.84 versus 0.77, p Ͻ 0.05).…”

Section: Specifi C Considerations In the Elderlymentioning

confidence: 99%

“…Inappropriate emergency treatment occurred in 162 (32%) patients, and led to a higher mortality (25% versus 11%; p Ͻ 0.001), highlighting the importance of an early accurate treatment in the ED. Numerous studies have evaluated and validated both natriuretic peptides in the diagnosis of CHF in middle-aged patients with acute dyspneoa 26,[30][31][32][33][34][35][36][37][38][39][40][41] ( Tables 2 and 3). All studies used the same methodology, with a measurement of BNP at admission in dyspneic patients in the emergency room.…”

Section: Physiologic Secretion Of Natriuretic Peptidesmentioning

confidence: 99%

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The Diagnostic Value of B Natriuretic Peptide in Elderly Patients with Acute Dyspnea

Delerme

Chenevier‐Gobeaux

Doumenc

et al. 2008

Clinical medicine. Cardiology

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Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial

Pivetta

Goffi

Nazerian

et al. 2019

European J of Heart Fail

171

107

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AimsAlthough acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool, but its diagnostic performance for ADHF has not been evaluated in randomized studies. We evaluated, in patients with acute dyspnoea, accuracy and clinical usefulness of combining LUS with clinical assessment compared to the use of chest radiography (CXR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation.This was a randomized trial conducted in two emergency departments. After initial clinical evaluation, patients with acute dyspnoea were classified by the treating physician according to presumptive aetiology (ADHF or non-ADHF). Patients were subsequently randomized to continue with either LUS or CXR/NT-proBNP. A new diagnosis, integrating the results of both initial assessment and the newly obtained findings, was then recorded. Diagnostic accuracy and clinical usefulness of LUS and CXR/NT-proBNP approaches were calculated. A total of 518 patients were randomized. Addition of LUS had higher accuracy [area under the receiver operating characteristic curve (AUC) 0.95] than clinical evaluation alone (AUC 0.88) in identifying ADHF (P < 0.01). In contrast, use of CXR/NT-proBNP did not significantly increase the accuracy of clinical evaluation alone (AUC 0.87 and 0.85, respectively; P > 0.05). The diagnostic accuracy of the LUS-integrated approach was higher then that of the CXR/Nt-proBNP-integrated approach (AUC 0.95 vs. 0.87, p < 0.01). Combining LUS with the clinical evaluation reduced diagnostic errors by 7.98 cases/100 patients, as compared to 2.42 cases/100 patients in the CXR/Nt-proBNP group.

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Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older

Abstract: BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older.

Cited by 72 publications

References 39 publications

A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

A meta‐analysis of the utility of pre‐operative brain natriuretic peptide in predicting early and intermediate‐term mortality and major adverse cardiac events in vascular surgical patients

The Diagnostic Value of B Natriuretic Peptide in Elderly Patients with Acute Dyspnea

Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial

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