N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department The ICON-RELOADED Study
N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department The ICON-RELOADED Study
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DOI：
10.1016/j.jacc.2018.01.021
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发表时间：
2018-03-20
影响因子：
24
通讯作者：
Gaggin, Hanna K.
中科院分区：
文献类型：
--
作者：
Januzzi, James L.;Chen-Tournoux, Annabel A.;Gaggin, Hanna K.
背景：当前需要重新考虑诊断n端前b型利钠肽（NT-proBNP）截止值对心力衰竭（HF）的诊断价值。目的：本研究旨在评估NT-proBNP对急诊科（ED）急性心力衰竭患者呼吸困难的诊断效果。方法纳入北美19个急诊科的呼吸困难患者，并抽血进行NT-proBNP测量。主要终点是诊断急性心衰的年龄分层截断值（450,900和1,800 pg/ml）的阳性预测值和排除急性心衰的排除截断值的阴性预测值。次要终点包括急性心衰的敏感性、特异性和阳性（+）和阴性（-）似然比（LRs）。结果1461名受试者中，277名（19%）被诊断为急性心衰。诊断急性心衰的受者-工作特征曲线下面积为0.91（95%可信区间[CI]: 0.90 ~ 0.93; p < 0.001）。450、900和1800 pg/ml的年龄分层临界值的敏感性分别为85.7%、79.3%和75.9%；特异性分别为93.9%、84.0%和75.0%。阳性预测值分别为53.6%、58.4%和62.0%。年龄相关的总体LR+为5.99 (95% CI: 5.05 ~ 6.93)；个体LR+年龄相关临界值分别为14.08、4.95和3.03。300 pg/ml排除临界值的敏感性和阴性预测值分别为93.9%和98.0%；LR -为0.09 （95% CI: 0.05 ~ 0.13）。结论：在急诊科的急性呼吸困难患者中，年龄分层的NT-proBNP切点可能有助于急性心衰的诊断。NT-proBNP < 300 pg/ml强烈排除急性心衰的存在。(c) 2018年由美国心脏病学会基金会颁发。
BACKGROUND Contemporary reconsideration of diagnostic N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed.OBJECTIVES This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting.METHODS Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (-) likelihood ratios (LRs) for acute HF.RESULTS Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR - was 0.09 (95% CI: 0.05 to 0.13).CONCLUSIONS In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP < 300 pg/ml strongly excludes the presence of acute HF. (c) 2018 by the American College of Cardiology Foundation.