Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure

Robaei, Daniel; Koe, Lisa; Bais, Renze; Gould, Irene; Stewart, Tanya; Tofler, Geoffrey H.

doi:10.1258/acb.2010.010137

Cited by 10 publications

(24 citation statements)

References 24 publications

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“…Specifically, an increased NT‐proBNP concentration was a stronger predictor of CHF than other variables evaluated including radiographic findings and clinical signs . In another study, the addition of BNP assay significantly increased diagnostic accuracy (from 53% to 71%) along with increased certainty (from 34% to 82%) in the assessment of people presenting to the emergency department for possible CHF. The additive value of NT‐proBNP testing to traditional diagnostic testing appears to be highest in cases in which diagnostic uncertainty is greatest .…”

Section: Discussionmentioning

confidence: 94%

“…The additional value of the NT‐proBNP assay as compared to traditional diagnostic tests such as physical examination, thoracic radiography, and serum biochemistry in individual cases has not been evaluated. In the emergency room setting in human medicine, information from BNP measurement combined with that obtained from clinical judgment increased diagnostic accuracy and decreased diagnostic uncertainty when evaluating dyspneic patients . Thus, we hypothesized that combining the NT‐proBNP assay with traditional diagnostic assessments (ie, history, physical examination, ECG, and thoracic radiography) would improve the accuracy and confidence of diagnoses made by general practitioners to discriminate between cardiac and noncardiac cause of respiratory distress in cats.…”

mentioning

confidence: 99%

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Effect of NT‐pro‐BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs

Singletary

Fox

Stepien

et al. 2012

Veterinary Internal Medicne

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Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) can distinguish congestive heart failure (CHF) from primary respiratory disease in cats with respiratory signs with approximately 90% diagnostic accuracy, but the additive benefit of NT-proBNP to improve the diagnosis obtained from conventional testing in individual cases remains unknown.Hypothesis: NT-proBNP will improve the diagnostic accuracy and confidence of general practice veterinarians in assessing cats with respiratory signs.Animals: Ten cats with respiratory signs. Methods: History, physical examination, thoracic radiographs, electrocardiogram (ECG), and biochemical analysis of 10 cats presented to the University of Pennsylvania or Tufts University with a history of respiratory signs were evaluated by 50 general practice veterinarians using an online survey tool. Participants were asked to provide (1) diagnosis of CHF or primary respiratory disease, and (2) level of confidence in their diagnosis (1, lowest to 10, highest) before and after disclosure of NT-proBNP results. Diagnoses (CHF, n = 5; primary respiratory, n = 5) were compared to the gold standard defined as consensus opinion of 3 board-certified cardiologists blinded to the NT-proBNP results.Results: Overall correctness of the practitioners was 69.2%, and significantly increased after practitioners were provided NT-proBNP results (87.0%, P = .0039). Median practitioner confidence before NT-proBNP disclosure was 6 (IQR, 5-8) and significantly increased after disclosure (8; IQR, 6-10; P = .0039).Conclusions: These data indicate a relatively low accuracy and level of confidence in the diagnosis of feline respiratory signs. Use of NT-proBNP assay in conjunction with conventional evaluation by general practitioners significantly improved their diagnostic accuracy and confidence.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Effect of NT‐pro‐BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs

Singletary

Fox

Stepien

et al. 2012

Veterinary Internal Medicne

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“…5NT-proBNP is a product of the pro-hormone brain natriuretic peptide which is released by cardiac myocytes when the ventricles are subject to haemodynamic stress [26] and is the current serological diagnostic marker of heart failure [21]. There is now a large literature on 5NT-proBNP in heart failure, which has clearly demonstrated that a normal blood 5NT-proBNP excludes cardiac failure in 99% of cases [20,21]. We measured EBC 5NT-proBNP in EBC in acutely dyspnoeic patients, and found that ACPO group had the highest numerical mean value, as expected.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesised that some breath biomarkers would be raised in CAP but not in ACPO or in a matched control group, while EBC pH would be decreased [16][17][18][19]. We also measured EBC 5N-terminal probrain natriuretic peptide (5NT-proBNP), a marker of cardiac myocyte injury, which is raised in the peripheral blood in heart failure [20,21].…”

Section: Introductionmentioning

confidence: 99%

Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema

Prazáková¹,

Elias²,

Thomas³

et al. 2015

Pulmonol Respir Res

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Introduction: Community-acquired pneumonia (CAP) and acute cardiogenic pulmonary oedema (ACPO) are common clinical conditions requiring hospital admission, but require different treatment. To assess whether exhaled breath analysis can distinguish between these, we measured exhaled breath condensate biomarkers and fractional exhaled nitric oxide (F E NO) in 14 patients with CAP and 12 patients with ACPO admitted acutely to hospital via the Emergency Department, comparing profiles with 15 control subjects. Methods: F E NO was measured using a NO Breath analyser and exhaled breath condensate (EBC) was collected for analysis of EBC biomarkers. EBC pH was measured with pH meter. The EBC biomarkers C-reactive protein (CRP), neopterin and 5N-terminal pro-brain natriuretic peptide (5NT-proBNP) were quantified using enzyme linked immunosorbent assays. Results: EBC 5NT-proBNP was raised in ACPO, while EBC CRP was raised in CAP. However, neopterin and pH showed no differences between groups. F E NO levels were significantly higher in CAP than in ACPO (p=0.03). Conclusions: This study demonstrates that exhaled breath analysis may be useful in assessing the acutely breathless patient, but that even this easy non-invasive technique is difficult for sick patients. More rapid measurements, application of novel biomarkers and combined assessment of several EBC biomarkers are likely to improve diagnostic differentiation in the future.

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“…However, it may also reflect the fact that physicians are generally more likely to discharge mildly symptomatic patients but not the very symptomatic ones. Robaei et al 16 have shown in 68 patients presenting to the ED with dyspnoea and possible heart failure that NT-proBNP testing improved diagnostic accuracy, however, they did not report the effect on admission. It seems that in practice when older and sicker patients are concerned, such as those enrolled in the present study, uncertainty dictates the need to admit whether the problem is ADHF or not.…”

Section: Diagnosis Of Adhf In the Edmentioning

confidence: 97%

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

Meisel

Januzzi

Medvedovski

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level is useful to diagnose or exclude acutely decompensated heart failure (ADHF) in dyspnoeic patients presenting to the emergency department (ED). Aim: To evaluate the impact of ED NT-proBNP testing on admission, length of stay (LOS), discharge diagnosis and longterm outcome. Methods: Dyspnoeic patients were randomized in the ED to NT-proBNP testing. Admission and discharge diagnoses, and outcomes were examined. Results: During 17 months, 470 patients were enrolled and followed for 2.0±1.3 years. ADHF likelihood, determined at study conclusion by validated criteria, established ADHF diagnosis as unlikely in 86 (17%), possible in 120 (24%), and likely in 293 (59%) patients. The respective admission rates in these subgroups were 80, 91, and 96%, regardless of blinding, and 61.9% of blinded vs. 74.5% of unblinded ADHF-likely patients were correctly diagnosed at discharge (p=0.029), with similar LOS. 2-year mortality within subgroups was unaffected by test, but was lower in ADHF-likely patients with NTproBNP levels below median (5000 pg/ml) compared with those above median (p=0.002). Incidence of recurrent cardiac events tracked NT-proBNP levels. Conclusion: ED NT-proBNP testing did not affect admission, LOS, 2-year survival, or recurrent cardiac events among study patients but improved diagnosis at discharge, and allowed risk stratification even within the ADHF-likely group. (ClinicalTrials.gov#NCT00271128)

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Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure

Abstract: Measurement of NT-proBNP concentrations reduces diagnostic uncertainty and improves diagnostic accuracy in patients presenting to the ED with dyspnoea and possible HF.

Cited by 10 publications

References 24 publications

Effect of NT‐pro‐BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs

Effect of NT‐pro‐BNP Assay on Accuracy and Confidence of General Practitioners in Diagnosing Heart Failure or Respiratory Disease in Cats with Respiratory Signs

Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema

Pre-admission NT-proBNP improves diagnostic yield and risk stratification – the NT-proBNP for EValuation of dyspnoeic patients in the Emergency Room and hospital (BNP4EVER) study

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