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Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure
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    Caveats for NT-pro0BNP in heart failure diagnosis

    Notwithstanding the assertion that the N-terminal pro-BNP-type natriuretic peptide(NT-proBNP) is highly sensitive and has excellent negative predictive value for heart failure(HF)[1], the following caveats may apply:-
    Firstly, the negative predictive value of NT-pro BNP is severely curtailed in HF patients who are obese(BMI 30.0 or more), with the consequence that low blood levels of that biomarker do not rule out a diagnosis of HF with preserved ejection fraction(HFpEF)[2]. In the latter study there were 30 patients with left ventricular ejection fraction of 50% or more who had complied with the European Society of Cardiology diagnostic criteria for HF. Twenty nine of the patients had a Body Mass Index(BMI) of 30.0 or more, and one had a BMI of 27(ie oeversight but not obese). Fifteen of the patients had NT-proBNP levels amounting to < 125 pg/ml[2]
    In the absence of the confounding effect of obesity, levels of NT-pro BNP below the diagnostic cut off level of 400 pg/ml also appear to be more prevalent in HFpEF patients than in patients with heart failure with reduced ejection fraction(HFrEF) [3]. In the latter study a comparison was made between 65 HFpEF patients and 50 patients with HFrEF. Mean values for BMI amounted to 24 in both subgroups. Criteria for HFpEF comprised symptoms of HF in association with echocardiographic documentation of an E/A ratio < 1 and left ventricular ejection fraction(LVEF) of 50% or more.. Criteria for HFr...

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    Conflict of Interest:
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