Zegard Abbasin, Naneishvili Tamara, Viyapurapu Ravi, Desai Purushottam, White Sam, Patel Peysh A, Stegemann Berthold, Zaphiriou Alex, Qiu Tian, Leyva Francisco
Aston Medical School, Aston University, Birmingham, UK.
Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK.
Open Heart. 2023 Oct;10(2). doi: 10.1136/openhrt-2023-002469.
To determine the diagnostic yield of a 'high' N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with suspected heart failure (HF) referred from primary to secondary care.
In this retrospective study, cardiac diagnoses were quantified in consecutive patients with an NT-proBNP>400 ng/L referred from primary care centres to a specialist HF service.
Among 654 consecutive patients (age: 78.5±9.72 years; 45.9% men; left ventricular ejection fraction (LVEF): 55.4±12.5% (mean±SD)), the primary diagnoses were: valvular disease (39.4%), HF (29.2%; 13.3% with LVEF<40%) and atrial fibrillation (AF; 17.3%). In terms of primary or secondary diagnoses, 68% of patients had valve disease, 46.9% had AF and 29.2% had HF. A cardiac diagnosis was made in 85.9%. In multivariable analyses, NT-proBNP predicted HF with LVEF<40% (OR: 10.2, 95% CI: 5.63 to 18.3) and HF with any LVEF (OR: 6.13, 95% CI: 3.79 to 9.93). In canonical linear discriminant analyses, NT-proBNP correctly identified 54.5% of patients with HF. The remainder were misclassified as valvular disease, AF or no cardiac diagnosis.
Among patients with an NT-proBNP>400 ng/L referred through a primary care HF pathway, most patients had valve disease or AF rather than HF. NT-proBNP cannot discriminate among HF, valve disease and AF. On this basis, NT-proBNP may be best employed in detecting cardiac disease in general rather than HF per se.
确定从初级保健转诊至二级保健的疑似心力衰竭（HF）患者中，“高”N末端脑钠肽前体（NT-proBNP）的诊断价值。
在这项回顾性研究中，对从初级保健中心转诊至专科HF服务中心且NT-proBNP>400 ng/L的连续患者进行心脏诊断量化。
在654例连续患者中（年龄：78.5±9.72岁；男性占45.9%；左心室射血分数（LVEF）：55.4±12.5%（均值±标准差）），主要诊断为：瓣膜病（39.4%）、HF（29.2%；LVEF<40%者占13.3%）和心房颤动（AF；17.3%）。就主要或次要诊断而言，68%的患者有瓣膜病，46.9%有AF，29.2%有HF。85.9%的患者做出了心脏诊断。在多变量分析中，NT-proBNP可预测LVEF<40%的HF（比值比：10.2，95%置信区间：5.63至18.3）以及任何LVEF的HF（比值比：6.13，95%置信区间：3.79至9.93）。在典型线性判别分析中，NT-proBNP正确识别出54.5%的HF患者。其余患者被错误分类为瓣膜病、AF或未做出心脏诊断。
在通过初级保健HF途径转诊且NT-proBNP>400 ng/L的患者中，大多数患者患有瓣膜病或AF而非HF。NT-proBNP无法区分HF、瓣膜病和AF。基于此，NT-proBNP可能最适合用于总体检测心脏疾病而非单纯检测HF。
