European Heart Journal Advance Access originally published online on November 17, 2005
European Heart Journal 2006 27(3):330-337; doi:10.1093/eurheartj/ehi631
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NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients
The International Collaborative of NT-proBNP Study
1Cardiology Division, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA 02114, USA
2Cardiology Department, University Hospital, Maastricht, The Netherlands
3Christchurch Cardioendocrine Research Group, Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
4Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
5Biochemistry Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
6Emergency Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Received 5 July 2005; revised 14 September 2005; accepted 13 October 2005; online publish-ahead-of-print 17 November 2005.
* Corresponding author. Tel: +1 617 726 3443; fax: +1 617 643 1620. E-mail address: jjanuzzi{at}partners.org
Aims Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents.
Methods and results Differences in NT-proBNP levels among 1256 patients with and without acute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P<0.001), and levels of NT-proBNP correlated with HF symptom severity (P=0.008). An optimal strategy to identify acute HF was to use age-related cut-points of 450, 900, and 1800 pg/mL for ages <50, 50–75, and >75, which yielded 90% sensitivity and 84% specificity for acute HF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to exclude acute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2–8.1, P<0.001].
Conclusion In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.
Key Words: Natriuretic peptides • Diagnosis • Prognosis
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