Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure
Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure
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DOI：
10.1016/j.amjcard.2004.01.042
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发表时间：
2004-05-01
影响因子：
2.8
通讯作者：
Nagueh, SF
中科院分区：
文献类型：
--
作者：
Dokainish, H;Zoghbi, WA;Nagueh, SF
B型利钠肽（BNP）和舒张早期二尖瓣血流速度/组织多普勒二尖瓣环血流速度（E/Ea）均能估计左室充盈压，但在充血性心力衰竭（CHF）的诊断中尚未进行比较。122例疑似CHF住院患者同时接受临床检查、BNP测量和全面超声多普勒检查。将BNP和超声心动图诊断CHF的准确性与Fragrant标准进行比较。70例患者（57%）有临床CHF，而52例（43%）没有。在所有患者中，最佳BNP临界值>250 pg/ml（敏感性86%，特异性77%）。E/Ea > 15的敏感性为83%，特异性为82%，而综合超声多普勒的敏感性为95%，特异性为88%。在射血分数正常的患者中，最佳BNP临界值为> 150 pg/ml（敏感性79%，特异性85%）。E/Ea > 15的敏感性为79%，特异性为93%，而综合超声多普勒的敏感性为85%，特异性为96%。在射血分数降低的患者中，最佳BNP临界值> 300 pg/ml（敏感性88%，特异性60%）。E/Ea > 15的敏感性为92%，特异性为72%，而综合超声多普勒的敏感性为96%，特异性为80%（与BNP相比，p = 0.08）。总体而言，BNP和E/Ea在该患者人群中对CHF的诊断准确性相似。在射血分数降低的患者中，综合超声多普勒对临床CHF的特异性倾向于高于BNP。(C)2004年，Excerpta Medica，Inc.
B-type natriuretic peptide (BNP) and early diastolic transmitral velocity/tissue Doppler mitral annular velocity (E/Ea) both estimate left ventricular filling pressure, but have not been compared in the diagnosis of congestive heart failure (CHF). One hundred twenty-two hospital inpatients with suspected CHF underwent simultaneous clinical examination, BNP measurement, and comprehensive echo-Doppler examination. The accuracy of BNP and echocardiography was compared with the Framingham criteria diagnosis of CHF. Seventy patients (57%) had clinical CHF, whereas 52 (43%) did not. In all patients, the optimal BNP cutoff was >250 pg/ml (sensitivity 86%, specificity 77%). E/Ea > 15 had 83% sensitivity and 82% specificity, whereas comprehensive echo-Doppler had 95% sensitivity and 88% specificity for CHF. In patients with normal ejection fraction, the optimal BNP cutoff was > 150 pg/ml (sensitivity 79%, specificity 85%). E/Ea > 15 had 79% sensitivity and 93% specificity, whereas comprehensive echo-Doppler had 85% sensitivity and 96% specificity for CHF. In patients with reduced ejection fraction, the optimal BNP cutoff was > 300 pg/ml (sensitivity 88%, specificity 60%). E/Ea > 15 had 92% sensitivity and 72% specificity, whereas comprehensive echo-Doppler had 96% sensitivity and 80% specificity (p = 0.08 compared with BNP) for CHF. Overall, BNP and E/Ea have similar diagnostic accuracy for CHF in this patient population. In patients with reduced ejection fraction, comprehensive echo-Doppler trended toward higher specificity than BNP for clinical CHF. (C) 2004 by Excerpta Medica, Inc.