Cardiology Department, Dumfries and Galloway Royal Infirmary, Dumfries, UK.
Cardiology Department, Forth Valley Royal Hospital, Larbert, UK.
ESC Heart Fail. 2022 Feb;9(1):627-635. doi: 10.1002/ehf2.13702. Epub 2021 Dec 8.
N terminal pro brain natriuretic peptide (NT-proBNP) is considered a rule-out test for patients with suspected heart failure. The NT-proBNP thresholds recommended for echocardiography by the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) are based on small studies of patients with heart failure and left ventricular (LV) systolic dysfunction (LVSD). The purpose of our study was to examine the relation between NT-proBNP and LVSD in a larger number of patients with symptoms suggestive of heart failure in a non-acute setting.
One thousand patients with suspected chronic heart failure underwent echocardiography within 6 months of NT-proBNP measurement. NT-proBNP was the strongest predictor of any form of LVSD in univariate (OR 2.52, 95% CI 2.19-2.91, P value < 0.001) and multivariate (OR 2.73, 95% CI 2.32-3.21, P value < 0.001) analyses. Negative predictive value (NPV) of NT-proBNP for impaired LV systolic function (ejection fraction 35-49%) was 98% at 125 pg/mL (the ESC threshold), 93% at 400 pg/mL (the NICE threshold), 91% at 1000 pg/mL and 90% at 2000 pg/mL. Corresponding values for severe LVSD (ejection fraction <35%) were 100%, 99%, 98% and 96%. The number of patients per 1000 with suspected chronic heart failure requiring echocardiography at each threshold was 851, 543, 324, and 182, respectively.
N terminal pro brain natriuretic peptide thresholds recommended by ESC and NICE result in large numbers of patients with suspected chronic heart failure being referred for echocardiography. Raising the NT-proBNP threshold would improve access to echocardiography with minimal negative impact on the clinical performance of this cardiac biomarker.
N 末端脑利钠肽前体（NT-proBNP）被认为是疑似心力衰竭患者的排除性检查。欧洲心脏病学会（ESC）和英国国家卫生与临床优化研究所（NICE）推荐的用于超声心动图的 NT-proBNP 阈值是基于心力衰竭和左心室（LV）收缩功能障碍（LVSD）患者的小样本研究。我们的研究目的是在非急性情况下，在更多有疑似心力衰竭症状的患者中检查 NT-proBNP 与 LVSD 之间的关系。
1000 例疑似慢性心力衰竭患者在 NT-proBNP 测量后 6 个月内行超声心动图检查。在单变量（OR 2.52，95%CI 2.19-2.91，P 值<0.001）和多变量（OR 2.73，95%CI 2.32-3.21，P 值<0.001）分析中，NT-proBNP 是任何形式的 LVSD 的最强预测因子。NT-proBNP 对左心室收缩功能受损（射血分数 35-49%）的阴性预测值（NPV）在 125pg/mL（ESC 阈值）时为 98%，在 400pg/mL（NICE 阈值）时为 93%，在 1000pg/mL 时为 91%，在 2000pg/mL 时为 90%。严重 LVSD（射血分数<35%）的相应值为 100%、99%、98%和 96%。在每个阈值下，每 1000 例疑似慢性心力衰竭患者中需要进行超声心动图检查的患者数分别为 851、543、324 和 182。
ESC 和 NICE 推荐的 NT-proBNP 阈值导致大量疑似慢性心力衰竭患者被转诊行超声心动图检查。提高 NT-proBNP 阈值将改善超声心动图的可及性，同时对该心脏生物标志物的临床性能影响最小。
