Rapid measurement of bnp in heart failure

Rapid measurement of bnp in emergency diagnosis of heart failure

1. Rapid Measurement of B-Type Natriuretic Peptide
in the Emergency Diagnosis of Heart Failure
Alan S. Maisel, M.D., Padma Krishnaswamy, M.D., Richard M. Nowak, M.D., M.B.A.,
James McCord, M.D., Judd E. Hollander, M.D., Philippe Duc, M.D., Torbjorn
Omland, M.D., Ph.D., Alan B. Storrow, M.D., William T. Abraham, M.D., Alan H.B.
Wu, Ph.D., Paul Clopton, M.S., Philippe G. Steg, M.D., Arne Westheim, M.D., Ph.D.,
M.P.H., Catherine Wold Knudsen, M.D., Alberto Perez, M.D., Radmila Kazanegra,
M.D., Howard C. Herrmann, M.D., Peter A. McCullough, M.D., M.P.H. and the
Breathing Not Properly Multinational Study Investigators
N Engl J Med
Volume 347;3:161-167
July 18, 2002

2. Study Overview
•B-type natriuretic peptide is released from the ventricles of the heart in
response to hemodynamic stress, and blood levels of B-type natriuretic
peptide may be useful in the diagnosis of heart failure
•In this study, a rapid, bedside immunoassay for B-type natriuretic
peptide was used to make or exclude the diagnosis of heart failure in
patients with acute dyspnea from various causes
•The assay was found to have good sensitivity and excellent specificity in
the diagnosis of heart failure
•Measurement of B-type natriuretic peptide levels is not a stand-alone
test for heart failure
•It will be of most value when used in conjunction with clinical
observations, especially when the cause of acute dyspnea is unclear
•The finding of a low level of B-type natriuretic peptide (less than 50 pg
per milliliter) is good evidence of the absence of heart failure

3. Base-Line Characteristics of 1586 Patients with Dyspnea
Maisel, A. et al. N Engl J Med 2002;347:161-167

4. Box Plots Showing Median Levels of B-Type Natriuretic Peptide Measured in the Emergency
Department in Three Groups of Patients
Maisel, A. et al. N Engl J Med 2002;347:161-167

5. Box Plots Showing Median Levels of B-Type Natriuretic Peptide among Patients in Each of the
Four New York Heart Association Classifications
Maisel, A. et al. N Engl J Med 2002;347:161-167

6. Receiver-Operating-Characteristic Curve for Various Cutoff Levels of B-Type Natriuretic Peptide
(BNP) in Differentiating between Dyspnea Due to Congestive Heart Failure and Dyspnea Due to
Other Causes
Maisel, A. et al. N Engl J Med 2002;347:161-167

7. Multiple Logistic-Regression Analysis of Factors Used for Differentiating between Patients with
and Those without Congestive Heart Failure
Maisel, A. et al. N Engl J Med 2002;347:161-167

8. Conclusions
•Used in conjunction with other clinical information, rapid measurement
of B-type natriuretic peptide is useful in establishing or excluding the
diagnosis of congestive heart failure in patients with acute dyspnea