Department of Internal Medicine, University of Basel, University Hospital, Switzerland.
Int J Cardiol. 2010 Jul 23;142(3):265-72. doi: 10.1016/j.ijcard.2008.12.214. Epub 2009 Jan 29.
This study aimed to examine the influence of history of heart failure (HF) on circulating levels, diagnostic accuracy and prognostic value of B-type natriuretic peptide (BNP) in patients presenting with all cause dyspnea at the emergency department.
BNP has been shown to be very helpful in diagnosis and prognosis of HF. Due to chronically elevated cardiac filling pressures, patients with a history of HF might have higher BNP levels and therefore diagnostic and prognostic properties of BNP may be affected.
We analyzed circulating levels, diagnostic accuracy and prognostic value of BNP in 388 patients without a previous history of HF and compared these to data to 64 patients with a history of HF included in the B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation (BASEL) Study.
Baseline BNP levels were higher in patients with a history of HF (median 814 pg/ml [353-1300 pg/ml] vs. 216 pg/ml [45-801 pg/ml], p<0.001). Diagnostic accuracy of BNP to identify HF was comparable in patients with (AUC=0.804; 95% CI 0.628-0.980) and in patients without history of HF (AUC=0.883; 95% CI 0.848-0.919, p=0.389). Prognostic ability of BNP to predict one-year mortality was lower in overall patients with history of HF (AUC=0.458; 95%CI 0.294-0.622) compared to patients without history of HF (AUC=0.710; 95% CI 0.653-0.768, p<0.05).
In patients with history of HF, BNP levels retain diagnostic accuracy. Ability to predict one-year mortality was decreased in unselected patients, but not in patients with acute HF-induced dyspnea.
本研究旨在探讨心力衰竭（HF）病史对因各种原因导致呼吸困难而就诊于急诊科的患者中循环 B 型利钠肽（BNP）水平、诊断准确性和预后价值的影响。
BNP 已被证明在 HF 的诊断和预后中有很大帮助。由于心脏充盈压长期升高，HF 病史患者的 BNP 水平可能较高，因此 BNP 的诊断和预后特性可能会受到影响。
我们分析了 388 例无 HF 病史患者的循环 BNP 水平、诊断准确性和预后价值，并将这些数据与包括在 B 型利钠肽用于急性呼吸困难评估（BASEL）研究中的 64 例 HF 病史患者的数据进行比较。
HF 病史患者的 BNP 水平基线较高（中位数 814 pg/ml [353-1300 pg/ml] 与 216 pg/ml [45-801 pg/ml]，p<0.001）。BNP 识别 HF 的诊断准确性在有（AUC=0.804；95%CI 0.628-0.980）和无 HF 病史的患者中相似（AUC=0.883；95%CI 0.848-0.919，p=0.389）。在总体 HF 病史患者中，BNP 预测一年死亡率的预后能力较低（AUC=0.458；95%CI 0.294-0.622），与无 HF 病史的患者相比（AUC=0.710；95%CI 0.653-0.768，p<0.05）。
在 HF 病史患者中，BNP 水平保留诊断准确性。在未选择的患者中，预测一年死亡率的能力降低，但在因急性 HF 导致呼吸困难的患者中并未降低。
