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
Cardiology and Angiology: An International Journal,
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.
- NT pro-BNP
How to Cite
Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirmovin R, Lenert L et al. Utility of B –type natriuretic peptide in the diagnosis of congestive heart failure in an urgent care setting. JACC. 2001;37(2): 379-85.
Girish B Ramteke, Lincy G Ramteke, Current concepts in management of congestive heart failure. Postgraduate Medicine (Emergency medicine-Emerging Discipline). 2008;197-211.
Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: Diagnosis, prognosis and measurements of diastolic function. Circulation. 2002;105:1387–1393.
Davis M, Espiner E, Richards G, Billings J, Town I, Neill A, Drennan C, et al. Plasma brain natriuretic peptide in assessing acute dyspnoea. Lancet. 1994;343:440–444.
Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue doppler imaging recordings. Am Heart J. 2004;148: 895–902.
Henry JP, Gauer OH, Reeves JL. Evidence of the atrial location of receptors influencing urine flow. Circ Res. 1956;4: 85-90.
Jagat Narula, James B. Young editorial natriuretic peptides in heart failure: Empathizing with the sobbing heart. Heart Failure Clinics. 2006;2:11-13.
Rasmus Mogelvang MD. Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnoea by plasma Pro-B-Type natriuretic peptide. JACC. 2007;50: 1694-701.
Annabel A et al. NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: Results from the ProBNP investigation of dyspnoea in the emergency department (PRIDE) echocardiographic substudy, European Heart Journal. 2006;27:839–45.
Januzzi JL, Filippatos G, Nieminen M, Gheorghiade M. Troponin elevation in patients with heart failure: On behalf of the third universal definition of myocardial infarction global task force: Heart Failure section. Eur Heart J. 2012;33:2265.
Amulya C. Belagavi Medha Rao, Aslam Y. Pillai correlation between NT proBNP and left ventricular ejection fraction in elderly patients presenting to the emergency department with dyspnea. Indian Heart Journal. 2012;64(3):302-4.
Volume II, Part 2. Bethesda MD. American Physiological Society, 1986;313– 63 3 American thoracic society: Dyspnoea mechanism, assessment and management: A consensus statement. Am J Respir Crit Care Med. 1999;159:321-40.
Sonal Virani, Pavan Kumar M, Sunil Dalvi. The correlation between NT pro-BNP levels and echocardiographic findings in a patient with acute onset dyspnea. J of Evolution of Medical and Dental Sciences. 2012;1(5):775-83.
Ioanna Zacharopoulou, Cristian Mornos, Adina Ionac, Stefan-Iosif Dragulescu. The relationship between tissue doppler parameters and serial NT-pro-BNP levels in patients with left ventricular dysfunction. TMJ. 2009;59:268-74.
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