2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience
D. Balaraju
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Vijay Kumar
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Chethan Kumar
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Hulliurudurga Srinivasa Setty Natraj Setty *
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Lakshman Shastry Sridhar
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Jayashree Kharge
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Rahul Patil
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Cholenahally Nanjappa Manjunath
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction.
Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality.
Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied.
Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46).
Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.
Keywords: Dyspnoeic, 2D-echocardiography, NT pro-BNP
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References
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