Gaggin Hanna Kim, Chen-Tournoux Annabel Angela, Christenson Robert H, Doros Gheorghe, Hollander Judd Eric, Levy Phillip David, Nagurney John Tobias, Nowak Richard Michael, Pang Peter S, Patel Darshita, Peacock Willam Frank, Walters Elizabeth Lea, Januzzi James Louis
Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Baim Institute for Clinical Research, Boston, MA, USA.
Jewish General Hospital, Montreal, PQ, Canada.
Am Heart J. 2017 Oct;192:26-37. doi: 10.1016/j.ahj.2017.07.002. Epub 2017 Jul 8.
The objectives were to reassess use of amino-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations for diagnosis and prognosis of acute heart failure (HF) in patients with acute dyspnea.
NT-proBNP facilitates diagnosis, prognosis, and treatment in patients with suspected or proven acute HF. As demographics of such patients are changing, previous diagnostic NT-proBNP thresholds may need updating. Additionally, value of in-hospital NT-proBNP prognostic monitoring for HF is less understood.
In a prospective, multicenter study in the United States and Canada, patients presenting to emergency departments with acute dyspnea were enrolled, with demographic, medication, imaging, and clinical course information collected. NT-proBNP analysis will be performed using the Roche Diagnostics Elecsys proBNPII immunoassay in blood samples obtained at baseline and at discharge (if hospitalized). Primary end points include positive predictive value of previously established age-stratified NT-proBNP thresholds for the adjudicated diagnosis of acute HF and its negative predictive value to exclude acute HF. Secondary end points include sensitivity, specificity, and positive and negative likelihood ratios for acute HF and, among those with HF, the prognostic value of baseline and predischarge NT-proBNP for adjudicated clinical end points (including all-cause death and hospitalization) at 30 and 180days.
A total of 1,461 dyspneic subjects have been enrolled and are eligible for analysis. Follow-up for clinical outcome is ongoing.
The International Collaborative of N-terminal pro-B-type Natriuretic Peptide Re-evaluation of Acute Diagnostic Cut-Offs in the Emergency Department study offers a contemporary opportunity to understand best diagnostic cutoff points for NT-proBNP in acute HF and validate in-hospital monitoring of HF using NT-proBNP.
目的是重新评估氨基末端B型利钠肽原（NT-proBNP）浓度在急性呼吸困难患者急性心力衰竭（HF）诊断和预后评估中的应用。
NT-proBNP有助于疑似或确诊急性HF患者的诊断、预后评估及治疗。由于此类患者的人口统计学特征正在发生变化，之前的NT-proBNP诊断阈值可能需要更新。此外，NT-proBNP在医院内对HF预后监测的价值尚不太清楚。
在美国和加拿大进行的一项前瞻性多中心研究中，纳入因急性呼吸困难就诊于急诊科的患者，并收集其人口统计学、用药、影像学及临床病程信息。将使用罗氏诊断公司的Elecsys proBNPII免疫分析法对在基线和出院时（若住院）采集的血样进行NT-proBNP分析。主要终点包括先前确定的按年龄分层的NT-proBNP阈值对判定急性HF诊断的阳性预测值及其排除急性HF的阴性预测值。次要终点包括急性HF的敏感性、特异性、阳性和阴性似然比，以及在HF患者中，基线和出院前NT-proBNP对30天和180天时判定的临床终点（包括全因死亡和住院）的预后价值。
共有1461名呼吸困难受试者入组并符合分析条件。临床结局随访正在进行中。
急诊室N末端B型利钠肽原急性诊断临界值重新评估国际协作研究提供了一个当代机会，以了解急性HF中NT-proBNP的最佳诊断临界值，并验证使用NT-proBNP对HF进行医院内监测的效果。
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