Send letter to journal:
Re: MULTI MARKER OR SINGLE MARKER, CLINICAL CORRELATION IS A MUST

It is known fact that emergency physicians misdiagnose heart failure in about 40% cases and these patients have high mortality rate of around 21%.The novel biomarkers like BNP assay significantly improves the accuracy of diagnosis of acute heart failure in patients presenting to the emergency department with dyspnea. The cut off point of 100 pg/ml, BNP has a sensitivity of 90% in isolation of clinical factors but the specificity is only 73 %.even though this study showed that the addition of MR-pro ANP has no clinically relevant increase in diagnostic accuracy, the combination of other biomarkers like MR ANP may significantly increase the diagnostic power in conditions like those with renal dysfunction, obesity, the elderly and those with edema as B type peptides can have some problems in these conditions .The BATCH trial has clearly showed that multi marker approach to the diagnosis of heart failure being superior to just using one. But the cost effectiveness and modest gains are not justifiable. Factors like gender (women have higher concentration), renal failure, acute coronary syndrome and stress may independently affect the value of BNP which emphasizes the importance of the clinical scenario in interpreting BNP values in emergency care setting. Another important thing is use of echocardiography along with the above diagnostic tools because BNP cannot differentiate systolic versus diastolic failure which is very important in treatment point of view. So even a single biomarker with highest diagnostic accuracy comes, clinical correlation with aid of existing diagnostic tools is the best approach.

Ref: 1. N Engl J Med. 2004 Feb 12;350(7):647-54. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea.Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P, Pfisterer M, Perruchoud AP.Department of Internal Medicine, Medical Division A, University of Basel, University Hospital, Basel, Switzerland. chmueller@uhbs.ch

2. Lancet. 2000 Apr 1;355(9210):1126-30. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations.Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM.Christchurch Cardioendocrine Research Group, Christchurch Hospital, New Zealand. richard.troughton@chmeds.ac.nz