Clinical study
Diagnostic value of B-Type natriuretic peptide and chest radiographic findings in patients with acute dyspnea

https://doi.org/10.1016/j.amjmed.2003.10.028Get rights and content

Abstract

Purpose

To compare chest radiographic findings and circulating B-type natriuretic peptide (BNP) levels as an adjunct to clinical findings in the diagnosis of heart failure in patients presenting with acute dyspnea.

Methods

The diagnostic performance of radiographic evidence of cardiomegaly/redistribution and BNP levels ≥100 pg/mL as indicators of heart failure were assessed in 880 patients presenting with acute dyspnea to the emergency departments of five U.S. and two European teaching hospitals. BNP levels were determined by a rapid, point-of-care device. Two blinded cardiologists reviewed all clinical data and categorized patients as to whether they had acute heart failure (n = 447) or not (n = 433).

Results

Three-factor analyses showed that BNP levels ≥100 pg/mL contributed significantly to the prediction of heart failure over each of the radiographic indicators. In a multivariate logistic regression analysis, both BNP levels ≥100 pg/mL (odds ratio [OR] = 12.3; 95% confidence interval [CI]: 7.4 to 20.4) and radiographic findings of cardiomegaly (OR = 2.3; 95% CI: 1.4 to 3.7), cephalization (OR = 6.4; 95% CI: 3.3 to 12.5), and interstitial edema (OR = 7.0; 95% CI: 2.9 to 17.0) added significant, predictive information above historical and clinical predictors of heart failure.

Conclusion

In patients presenting to the emergency department with acute dyspnea, BNP levels and chest radiographs provide complementary diagnostic information that may be useful in the early evaluation of heart failure.

Section snippets

Patients

The Breathing Not Properly Multinational Study included 1586 patients recruited from five U.S. and two European teaching hospitals (Veterans Affairs Medical Center, California; Henry Ford Hospital, Michigan; University of Cincinnati College of Medicine, Ohio; Hospital of the University of Pennsylvania; Hartford Hospital, Connecticut; Hôpital Bichat, France; Ullevål University Hospital, Norway) from June 1999 to December 2000. To be eligible for the study, patients had to present to the

Results

The analysis comprised 880 patients with a mean (± SD) age of 64 ± 16 years, of whom 55% (n = 482) were men. Fifty-six percent were black (n = 495) and 39% (n = 340) were white. The most common final diagnosis was acute heart failure (51%) (Table 1). Four percent were considered to have a history of chronic heart failure, but current dyspnea due to other condition, and 45% had no current or past heart failure. The Framingham criteria for heart failure were fulfilled in 66% of patients (n =

Discussion

In our study of patients presenting to the emergency department with acute dyspnea, we found that BNP measurements and chest radiographs provided complementary diagnostic information beyond that derived from historical and clinical variables. Although BNP appeared to be the single strongest predictor of the diagnosis of acute heart failure, suggesting that BNP measurement should be performed routinely in the acutely dyspneic patient, these results also support the continued practice of

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