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European Heart Journal Advance Access originally published online on March 1, 2006
European Heart Journal 2006 27(7):839-845; doi:10.1093/eurheartj/ehi811
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy

Annabel A. Chen, Malissa J. Wood, Daniel G. Krauser, Aaron L. Baggish, Roderick Tung, Saif Anwaruddin, Michael H. Picard and James L. Januzzi*

Division of Cardiology, Cardiac Ultrasound Laboratory, and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Yawkey 5984, 55 Fruit Street, Boston, MA 02114, USA

Received 30 November 2005; revised 30 January 2006; accepted 3 February 2006; online publish-ahead-of-print 1 March 2006.

* Corresponding author. Tel: +1 617 726 3443; fax: +1 617 643 1620. E-mail address: jjanuzzi{at}partners.org

Aims The objective of this study was to determine the integrative utility of measuring plasma NT-proBNP levels with echocardiography in the evaluation of dyspnoeic patients.

Methods and results Of 599 emergency department patients enrolled in a clinical study of NT-proBNP at a tertiary-care hospital, 134 (22%) had echocardiographic results available for analysis. Echocardiographic parameters correlating with NT-proBNP levels were determined using multivariable linear-regression analysis. Independent predictors of 1-year mortality were determined using Cox-proportional hazard analysis. Independent relationships were found between NT-proBNP levels and ejection fraction (P=0.012), tissue Doppler early and late mitral annular diastolic velocities (P=0.007 and 0.018), right ventricular (RV) hypokinesis (P=0.006), and tricuspid regurgitation severity (P<0.001) and velocity (P=0.007). An NT-proBNP level <300 pg/mL had a negative predictive value of 91% for significant left ventricular systolic and diastolic dysfunction. Overall 1-year mortality was 20.1% and was independently predicted by NT-proBNP level [HR 8.65, 95% confidence interval (CI) 2.7–27.8, P=0.0003], ejection fraction (HR 0.95, 95% CI 0.91–0.99, P=0.009), RV dilation (HR 2.98, 95% CI 1.05–12.8, P=0.04), and systolic blood pressure (HR 0.97, 95% CI 0.96–0.99, P=0.01).

Conclusion NT-proBNP levels correlate with, and provide important prognostic information beyond, echocardiographic parameters of cardiac structure and function. Routine NT-proBNP testing may thus be useful to triage patients to more timely or deferred echocardiographic evaluation.

Key Words: Natriuretic peptides • Heart failure • Echocardiography


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