Natriuretic peptides and echocardiography in acute dyspnoea: Implication of elevated levels with normal systolic function

Keyur B. Shah, Willem J. Kop, Robert H. Christenson, Deborah B. Diercks, Dick Kuo, Sue Henderson, Karen Hanson, Shu Ying Li, Christopher R. Defilippi

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

AimsPrevious evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.Methods and resultsProspective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37 of patients and 13 died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF ≤ 40 was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF ≥ 50. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF ≥ 50.ConclusionIn an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.

Original languageEnglish (US)
Pages (from-to)659-667
Number of pages9
JournalEuropean Journal of Heart Failure
Volume11
Issue number7
DOIs
StatePublished - Jul 2009

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Natriuretic Peptides
Dyspnea
Echocardiography
Hospital Emergency Service
Brain Natriuretic Peptide
Heart Failure
Mortality
Population
pro-brain natriuretic peptide (1-76)

Keywords

  • Echocardiography
  • Heart failure
  • Natriuretic peptides
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Natriuretic peptides and echocardiography in acute dyspnoea : Implication of elevated levels with normal systolic function. / Shah, Keyur B.; Kop, Willem J.; Christenson, Robert H.; Diercks, Deborah B.; Kuo, Dick; Henderson, Sue; Hanson, Karen; Li, Shu Ying; Defilippi, Christopher R.

In: European Journal of Heart Failure, Vol. 11, No. 7, 07.2009, p. 659-667.

Research output: Contribution to journalArticle

Shah, Keyur B. ; Kop, Willem J. ; Christenson, Robert H. ; Diercks, Deborah B. ; Kuo, Dick ; Henderson, Sue ; Hanson, Karen ; Li, Shu Ying ; Defilippi, Christopher R. / Natriuretic peptides and echocardiography in acute dyspnoea : Implication of elevated levels with normal systolic function. In: European Journal of Heart Failure. 2009 ; Vol. 11, No. 7. pp. 659-667.
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abstract = "AimsPrevious evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.Methods and resultsProspective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37 of patients and 13 died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF ≤ 40 was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF ≥ 50. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF ≥ 50.ConclusionIn an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.",
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T1 - Natriuretic peptides and echocardiography in acute dyspnoea

T2 - Implication of elevated levels with normal systolic function

AU - Shah, Keyur B.

AU - Kop, Willem J.

AU - Christenson, Robert H.

AU - Diercks, Deborah B.

AU - Kuo, Dick

AU - Henderson, Sue

AU - Hanson, Karen

AU - Li, Shu Ying

AU - Defilippi, Christopher R.

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N2 - AimsPrevious evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.Methods and resultsProspective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37 of patients and 13 died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF ≤ 40 was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF ≥ 50. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF ≥ 50.ConclusionIn an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.

AB - AimsPrevious evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in 'all-comers' with acute dyspnoea.Methods and resultsProspective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37 of patients and 13 died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF ≤ 40 was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF ≥ 50. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF ≥ 50.ConclusionIn an acute dyspnoea population with 'all-comers' undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.

KW - Echocardiography

KW - Heart failure

KW - Natriuretic peptides

KW - Prognosis

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