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The N-terminal Pro-BNP Investigation of Dyspnea in the Emergency department (PRIDE) study

      The utility of aminoterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department to rule out acute congestive heart failure (CHF) and the optimal cutpoints for this use are not established. We conducted a prospective study of 600 patients who presented in the emergency department with dyspnea. The clinical diagnosis of acute CHF was determined by study physicians who were blinded to NT-proBNP results. The primary end point was a comparison of NT-proBNP results with the clinical assessment of the managing physician for identifying acute CHF. The median NT-proBNP level among 209 patients (35%) who had acute CHF was 4,054 versus 131 pg/ml among 390 patients (65%) who did not (p <0.001). NT-proBNP at cutpoints of >450 pg/ml for patients <50 years of age and >900 pg/ml for patients ≥50 years of age were highly sensitive and specific for the diagnosis of acute CHF (p <0.001). An NT-proBNP level <300 pg/ml was optimal for ruling out acute CHF, with a negative predictive value of 99%. Increased NT-proBNP was the strongest independent predictor of a final diagnosis of acute CHF (odds ratio 44, 95% confidence interval 21.0 to 91.0, p <0.0001). NT-proBNP testing alone was superior to clinical judgment alone for diagnosing acute CHF (p = 0.006); NT-proBNP plus clinical judgment was superior to NT-proBNP or clinical judgment alone. NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting.
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      References

        • Davis M.
        • Espiner E.
        • Richards G.
        • Billings J.
        • Town I.
        • Neill A.
        • Drennan C.
        • Richards M.
        • Turner J.
        • Yandle T.
        Plasma brain natriuretic peptide in assessment of acute dyspnoea.
        Lancet. 1994; 343: 440-444
        • Dao Q.
        • Krishnaswamy P.
        • Kazanegra R.
        • Harrison A.
        • Amirnovin R.
        • Lenert L.
        • Clopton P.
        • Alberto J.
        • Hlavin P.
        • Maisel A.S.
        Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting.
        J Am Coll Cardiol. 2001; 37: 379-385
        • Maisel A.S.
        • Krishnaswamy P.
        • Nowak R.M.
        • McCord J.
        • Hollander J.E.
        • Duc P.
        • Omland T.
        • Storrow A.B.
        • Abraham W.T.
        • Wu A.H.
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        N Engl J Med. 2002; 347: 161-167
        • Lainchbury J.G.
        • Campbell E.
        • Frampton C.M.
        • Yandle T.G.
        • Nicholls M.G.
        • Richards A.M.
        Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath.
        J Am Coll Cardiol. 2003; 42: 728-735
        • Bayes-Genis A.
        • Santalo-Bel M.
        • Zapico-Muniz E.
        • Lopez L.
        • Cotes C.
        • Bellido J.
        • Leta R.
        • Casan P.
        • Ordonez-Llanos J.
        N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction.
        Eur J Heart Fail. 2004; 6: 301-308
        • McCullough P.A.
        • Nowak R.M.
        • McCord J.
        • Hollander J.E.
        • Herrmann H.C.
        • Steg P.G.
        • Duc P.
        • Westheim A.
        • Omland T.
        • Knudsen C.W.
        • et al.
        B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study.
        Circulation. 2002; 106: 416-422
        • Alpert J.S.
        • Thygesen K.
        • Antman E.
        • Bassand J.P.
        Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.
        J Am Coll Cardiol. 2000; 36: 959-969
        • Kannel W.B.
        • D'Agostino R.B.
        • Silbershatz H.
        • Belanger A.J.
        • Wilson P.W.
        • Levy D.
        Profile for estimating risk of heart failure.
        Arch Intern Med. 1999; 159: 1197-1204
        • Packer M.
        Should B-type natriuretic peptide be measured routinely to guide the diagnosis and management of chronic heart failure?.
        Circulation. 2003; 108: 2950-2953
        • Mark D.B.
        • Felker G.M.
        B-type natriuretic peptide—a biomarker for all seasons?.
        N Engl J Med. 2004; 350: 718-720
        • Groenning B.A.
        • Raymond I.
        • Hildebrandt P.R.
        • Nilsson J.C.
        • Baumann M.
        • Pedersen F.
        Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population.
        Heart. 2004; 90: 297-303
        • Groenning B.A.
        • Nilsson J.C.
        • Sondergaard L.
        • Pedersen F.
        • Trawinski J.
        • Baumann M.
        • Larsson H.B.
        • Hildebrandt P.R.
        Detection of left ventricular enlargement and impaired systolic function with plasma N-terminal pro brain natriuretic peptide concentrations.
        Am Heart J. 2002; 143: 923-929
        • Bay M.
        • Kirk V.
        • Parner J.
        • Hassager C.
        • Nielsen H.
        • Krogsgaard K.
        • Trawinski J.
        • Boesgaard S.
        • Aldershvile J.
        NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function.
        Heart. 2003; 89: 150-154
        • Raymond I.
        • Groenning B.A.
        • Hildebrandt P.R.
        • Nilsson J.C.
        • Baumann M.
        • Trawinski J.
        • Pedersen F.
        The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population.
        Heart. 2003; 89: 745-751
        • James S.K.
        • Lindahl B.
        • Siegbahn A.
        • Stridsberg M.
        • Venge P.
        • Armstrong P.
        • Barnathan E.S.
        • Califf R.
        • Topol E.J.
        • Simoons M.L.
        • Wallentin L.
        N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy.
        Circulation. 2003; 108: 275-281
        • Jernberg T.
        • Stridsberg M.
        • Venge P.
        • Lindahl B.
        N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation.
        J Am Coll Cardiol. 2002; 40: 437-445
        • Jernberg T.
        • Lindahl B.
        • Siegbahn A.
        • Andren B.
        • Frostfeldt G.
        • Lagerqvist B.
        • Stridsberg M.
        • Venge P.
        • Wallentin L.
        N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease.
        J Am Coll Cardiol. 2003; 42: 1909-1916
        • Kucher N.
        • Printzen G.
        • Doernhoefer T.
        • Windecker S.
        • Meier B.
        • Hess O.M.
        Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism.
        Circulation. 2003; 107: 1576-1578
        • McCullough P.A.
        • Duc P.
        • Omland T.
        • McCord J.
        • Nowak R.M.
        • Hollander J.E.
        • Herrmann H.C.
        • Steg P.G.
        • Westheim A.
        • Knudsen C.W.
        • et al.
        B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study.
        Am J Kidney Dis. 2003; 41: 571-579
        • Morrison L.K.
        • Harrison A.
        • Krishnaswamy P.
        • Kazanegra R.
        • Clopton P.
        • Maisel A.
        Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea.
        J Am Coll Cardiol. 2002; 39: 202-209
        • Mueller C.
        • Scholer A.
        • Laule-Kilian K.
        • Martina B.
        • Schindler C.
        • Buser P.
        • Pfisterer M.
        • Perruchoud A.P.
        Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea.
        N Engl J Med. 2004; 350: 647-654
        • Yeo K.T.
        • Wu A.H.
        • Apple F.S.
        • Kroll M.H.
        • Christenson R.H.
        • Lewandrowski K.B.
        • Sedor F.A.
        • Butch A.W.
        Multicenter evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay.
        Clin Chim Acta. 2003; 338: 107-115
        • Prontera C.
        • Emdin M.
        • Zucchelli G.C.
        • Ripoli A.
        • Passino C.
        • Clerico A.
        Analytical performance and diagnostic accuracy of a fully-automated electrochemiluminescent assay for the N-terminal fragment of the pro-peptide of brain natriuretic peptide in patients with cardiomyopathy: comparison with immunoradiometric assay methods for brain natriuretic peptide and atrial natriuretic peptide.
        Clin Chem Lab Med. 2004; 42: 37-44
        • Mueller T.
        • Gegenhuber A.
        • Poelz W.
        • Haltmayer M.
        Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and asymptomatic structural heart disease.
        Clin Chim Acta. 2004; 341: 41-48