N-Terminal Pro–B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure

Abstract

Background-The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking. Methods and Results-We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure (PϽ0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; Pϭ0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; Pϭ0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US $6129 to US $5180 per patient; Pϭ0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 (PϽ0.00001). Conclusions-In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes. (Circulation. 2007;115:3103-3110.)

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

“…18,23,24) Plasma NT-pro BNP level is commonly increased in patients undergoing MC implantation, and preceding studies demonstrated that a higher baseline natriuretic peptide level was strongly associated with worse long-term outcomes after MC. 12,25) MC is attracting clinical interest as a therapeutic option for not only severe MR but also HF.…”

Correlation analysis of the relationship between B-type natriuretic peptide and selected echocardiographic parameters in patients with permanent pacemakers

“…A BNP level that is elevated above 400 pg/ml means that the probability of heart failure and cardiac origin of dyspnoea is above 95% [4][5][6][7]. Elevated BNP in the blood positively correlates with the prognosis and NYHA class, intraventricular pressure, and pulmonary artery pressure, whereas it negatively correlates with cardiac output [8,9].…”

Diagnostisk treffsikkerhet for hjertesvikt – data fra Akershus hjerteundersøkelse 2

“…Treffsikkerhet når det gjelder NT-proBNP-må-ling for å skille hjertesvikt fra ikke-hjertesvikt var også like høy i vår studie som i internasjonale multisenterstudier (7).…”