Laboratoire de Biologie, Hôpital Emile-Roux, Assistance Publique Hôpitaux de Paris, 1 avenue de Verdun, 94456 Limeil-Brévannes, France.
Arch Gerontol Geriatr. 2011 Jan-Feb;52(1):106-10. doi: 10.1016/j.archger.2010.02.010. Epub 2010 Mar 11.
Confirming the presence of heart failure (HF) in geriatric patients is made difficult by the overlapping symptoms with other diseases and by limited access to investigative techniques such as echography, and the clinical signs are either non-constant or difficult to interpret. In this context, BNP measurement could prove highly useful. We determined a cut-off value of BNP for diagnosing HF in geriatric patients and gauged its predictive power in terms of cardiovascular events, dependence and death within a 6-month timeframe. This clinical and biological study was performed in patients, 44 women and 20 men, age>65 years with suspected HF hospitalized in the geriatric unit at Emile-Roux hospital. Echography was performed at baseline examination. BNP concentrations were determined at baseline examination and at 2 and 6 months later. Renal function was assessed via the Cockroft-Gault formula. Nutritional status was assessed using the geriatric nutritional risk index (GNRI). Final reference diagnosis was established by both cardiologist and geriatrician. The diagnostic value of BNP was assessed by area under the ROC curve. The average age of the 64 patients was 84.3±7.4 years. The final diagnosis was HF in 26 patients (41%). A BNP<129pg/ml had a negative predictive value of 90% (accuracy 80%) for excluding the diagnosis of HF. BNP values were predictive of cardiovascular events over a 2-month timeframe in patients with HF and over a 6-month timeframe in the global population. BNP values were not predictive of mortality in patients with or without HF. BNP testing should help to differentiate pulmonary from cardiac etiologies of dyspnea, but a specific cut-off point has to be used in geriatric settings, mainly for patients presenting nutritional and renal dysfunctions.
在老年患者中确认心力衰竭（HF）的存在很困难，因为其症状与其他疾病重叠，并且无法获得超声心动图等检查技术，而且临床体征不是恒定的，也难以解释。在这种情况下，BNP 测量可能非常有用。我们确定了 BNP 用于诊断老年患者 HF 的截断值，并评估了其在 6 个月内预测心血管事件、依赖性和死亡率的能力。这项临床和生物学研究在 Emile-Roux 医院老年病房住院的疑似 HF 的 65 岁以上的 44 名女性和 20 名男性患者中进行。在基线检查时进行了超声心动图检查。在基线检查时以及 2 个月和 6 个月后测定了 BNP 浓度。通过 Cockroft-Gault 公式评估肾功能。使用老年营养风险指数（GNRI）评估营养状况。最终参考诊断由心脏病专家和老年病学家共同确定。通过 ROC 曲线下面积评估 BNP 的诊断价值。64 名患者的平均年龄为 84.3±7.4 岁。最终诊断为心力衰竭的患者有 26 名（41%）。BNP<129pg/ml 时，排除 HF 诊断的阴性预测值为 90%（准确率为 80%）。在心力衰竭患者中，BNP 值可预测 2 个月内的心血管事件，在整个人群中可预测 6 个月内的心血管事件。BNP 值不能预测心力衰竭患者或无心力衰竭患者的死亡率。BNP 检测有助于区分呼吸困难的肺部和心脏病因，但在老年人群中，特别是对于存在营养和肾功能障碍的患者，需要使用特定的截断值。
