Verdú José M, Comín-Colet Josep, Domingo Mar, Lupón Josep, Gómez Miguel, Molina Luis, Casacuberta Jose M, Muñoz Miguel A, Mena Amparo, Bruguera-Cortada Jordi
Equip d'Atenció Primària, Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2012 Jul;65(7):613-9. doi: 10.1016/j.recesp.2012.01.019. Epub 2012 Apr 26.
Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care.
Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data).
Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms.
In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnoses and could be cost-effectiveness.
对于疑似心力衰竭的患者，可能建议在进行超声心动图检查之前检测利钠肽。基层医疗中用于心力衰竭诊断的截断点尚未明确确立。我们旨在评估基层医疗中社区人群N末端B型利钠肽原（NT-proBNP）的最佳诊断截断值。
在一家基层医疗中心对快速即时检测NT-proBNP进行前瞻性诊断准确性研究。纳入因疑似心力衰竭由全科医生转诊至超声心动图检查的连续患者。进行基于弗雷明汉标准的临床病史和体格检查、心电图、胸部X线、NT-proBNP检测及超声心动图检查。由一位对NT-proBNP值不知情的心脏病专家依据欧洲心脏病学会诊断标准（临床和超声心动图数据）做出心力衰竭诊断。
共评估220例患者（65.5%为女性；中位年龄74岁[四分位间距67 - 81岁]）。52例患者（23.6%）确诊为心力衰竭，其中16例（30.8%）左心室射血分数<50%（39.6[5.1]%）。心力衰竭患者和无心力衰竭患者的NT-proBNP中位值分别为715 pg/mL[四分位间距510.5 - 1575]和77.5 pg/mL[四分位间距58 - 179.75]。最佳截断点为280 pg/mL，受试者工作特征曲线下面积为0.94（95%置信区间，0.91 - 0.97）。6例心力衰竭确诊患者（11.5%）的NT-proBNP值<400 pg/mL。检测利钠肽可避免67%的超声心动图检查需求。
在基层医疗的社区人群中，排除心力衰竭的NT-proBNP最佳截断点为280 pg/mL。检测NT-proBNP可改善诊断流程且可能具有成本效益。
