Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure
Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure
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DOI：
10.1056/nejmoa020233
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发表时间：
2002-07-18
影响因子：
158.5
通讯作者：
McCullough, PA
中科院分区：
文献类型：
--
作者：
Maisel, AS;Krishnaswamy, P;McCullough, PA
背景B型利钠肽是释放的心室壁tension.Methods增加，我们进行了一项前瞻性研究的1586例患者来到急诊科急性呼吸困难，其B型利钠肽测定与床边分析。充血性心力衰竭的临床诊断由两名独立的心脏病专家裁定，他们对B型利钠肽测定的结果不知情。结果744例患者的最终诊断为充血性心力衰竭引起的呼吸困难（47%），72例有左心室功能不全病史的患者因非心源性原因导致呼吸困难770例患者（49%）未发现充血性心力衰竭。在确定充血性心力衰竭是呼吸困难的原因方面，B型利钠肽水平本身比任何病史或体格检查结果或实验室检查值更准确。B型利钠肽在100 pg/ml的临界值下的诊断准确率为83.4%。B型利钠肽水平低于50 pg/ml时的阴性预测值为96%。在多元Logistic回归分析中，测量B型利钠肽增加了显着的独立预测能力，其他临床变量的模型预测哪些患者有充血性heartfault.Conclusions与其他临床信息结合使用，快速测量B型利钠肽是有用的，在建立或排除充血性心力衰竭的诊断急性呼吸困难患者。
Background B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension.Methods We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay.Results The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure.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.