Bima Paolo, Wussler Desirée, Lopez-Ayala Pedro, Belkin Maria, Nowak Albina, Lin Xueting, Strebel Ivo, Sgueglia Fabiana, Michou Eleni, Papachristou Androniki, Chollet Laureve, Popescu Codruta, Kozhuharov Nikola, Shrestha Samyut, Kuster Gabriela, Rentsch Katharina, Von Eckardstein Arnold, Binder Mascha, Mahfoud Felix, Breidthardt Tobias, Mueller Christian
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Medical Sciences, University of Torino, Turin, Italy.
Eur J Heart Fail. 2025 Jun 30. doi: 10.1002/ejhf.3752.
Among cancer patients presenting with acute dyspnoea, the prevalence of acute heart failure (AHF), resource use and diagnostic accuracy of natriuretic peptides remain unknown. This study aimed to address these knowledge gaps.
Patients presenting with acute dyspnoea to the emergency department (ED) were prospectively enrolled in a multicentre diagnostic study. AHF was centrally adjudicated by two independent cardiologists based on current guidelines. B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) concentrations were measured at ED presentation. Cancer status, resource use, and long-term outcomes were prospectively assessed. Among 2153 patients, 473 (22.0%) had an active or past cancer. AHF was the most common final diagnosis in both cancer and non-cancer patients (44.4% vs. 51.0%, p = 0.01). Among the alternative diagnoses, pneumonia and cancer-related dyspnoea were more frequent in patients with cancer, while anxiety disorder/hyperventilation was frequent in patients without cancer. Hospitalization rate and length of hospital stay were both higher in cancer patients (p < 0.01). Among AHF-related signs, rales and pleural effusion showed a significant interaction with cancer status and had lower diagnostic accuracy in cancer patients. The area under the curve (AUC) of NT-proBNP was lower in cancer than in non-cancer patients (0.89 vs. 0.93, p = 0.01), while that of BNP was similar (0.93 vs. 0.95, p = ns). This difference was mainly due to active cancers.
Acute heart failure was the most common diagnosis in cancer patients presenting with acute dyspnoea. Rales, pleural effusion, and NT-proBNP had lower diagnostic accuracy versus patients without cancer, while that of BNP remained robust.
在出现急性呼吸困难的癌症患者中，急性心力衰竭（AHF）的患病率、资源利用情况以及利钠肽的诊断准确性尚不清楚。本研究旨在填补这些知识空白。
前瞻性纳入在急诊科（ED）出现急性呼吸困难的患者进行多中心诊断研究。由两名独立的心脏病专家根据现行指南对AHF进行集中判定。在ED就诊时测量B型利钠肽（BNP）和N末端脑钠肽前体（NT-proBNP）浓度。前瞻性评估癌症状态、资源利用情况和长期结局。在2153例患者中，473例（22.0%）患有活动性或既往癌症。AHF是癌症患者和非癌症患者中最常见的最终诊断（44.4%对51.0%，p = 0.01）。在其他诊断中，肺炎和癌症相关呼吸困难在癌症患者中更常见，而焦虑症/过度通气在非癌症患者中更常见。癌症患者的住院率和住院时间均更高（p < 0.01）。在与AHF相关的体征中，啰音和胸腔积液与癌症状态存在显著交互作用，在癌症患者中的诊断准确性较低。NT-proBNP的曲线下面积（AUC）在癌症患者中低于非癌症患者（0.89对0.93，p = 0.01），而BNP的曲线下面积相似（0.93对0.95，p = 无统计学意义）。这种差异主要归因于活动性癌症。
急性心力衰竭是出现急性呼吸困难的癌症患者中最常见的诊断。与非癌症患者相比，啰音、胸腔积液和NT-proBNP的诊断准确性较低，而BNP的诊断准确性仍然较高。
