Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
J Card Fail. 2011 Sep;17(9):729-34. doi: 10.1016/j.cardfail.2011.04.013. Epub 2011 May 28.
In patients suspected of new slow-onset heart failure, data on the comparative diagnostic performance of automated B-type natriuretic peptide (BNP) assays are scarce.
Two hundred patients referred to a heart failure outpatient diagnostic facility underwent standard diagnostic work-up including echocardiography. The reference standard for the diagnosis of heart failure was an expert panel conclusion. N-terminal pro-BNP on Elecsys and BNP on Axsym and Centaur machines were measured in a single batch. Data were available for 172 patients; 51 had heart failure (29.7%). All 3 tests had high c-statistic values. An intermediate-risk subset of 111 patients (34% with heart failure) was created by excluding patients with very high or very low probability based on history and physical examination, the subgroup most in need of an additional test. Applying different thresholds for ruling heart failure in or out, the positive predicted values in this "gray zone" group were 75%, 76%, and 72%, respectively, and the negative predictive values 83%, 71%, and 85%, with the remaining 50% of patients having ∼18% probability of heart failure.
In practice, a valid diagnosis in patients suspected of slow-onset heart failure remains elusive for many in the absence of echocardiographic imaging.
对于疑似新发缓速型心力衰竭的患者，有关自动化 B 型利钠肽（BNP）检测比较诊断性能的数据十分有限。
200 例因疑似心力衰竭而到心力衰竭门诊诊断机构就诊的患者接受了包括超声心动图在内的标准诊断检查。心力衰竭的诊断标准是专家组的结论。Elecsys 上的 N 末端 pro-BNP 和 Axsym 及 Centaur 仪器上的 BNP 被一次性检测。共获得 172 例患者的数据；其中 51 例患者患有心力衰竭（29.7%）。所有 3 项检测均具有较高的 C 统计量值。通过基于病史和体格检查排除具有极高或极低可能性的患者，创建了一个中间风险亚组（心力衰竭发生率为 34%）。在该“灰色区域”组中，采用不同的界值来排除或确诊心力衰竭，阳性预测值分别为 75%、76%和 72%，阴性预测值分别为 83%、71%和 85%，其余 50%的患者心力衰竭的可能性约为 18%。
在实践中，对于许多没有超声心动图图像的疑似缓速型心力衰竭患者，仍难以进行有效的诊断。
