Elsevier

The Lancet

Volume 343, Issue 8895, 19 February 1994, Pages 440-444
The Lancet

Articles
Plasma brain natriuretic peptide in assessment of acute dyspnoea

https://doi.org/10.1016/S0140-6736(94)92690-5Get rights and content

Abstract

Recognition of heart failure (HF) may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction. Since increased secretion of the cardiac hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) occurs early in the course of HF, we have assessed the value of measuring these hormones in plasma in the diagnosis of suspected HF in 52 elderly patients presenting with acute dyspnoea, and compared values with left-ventricular ejection fraction (LVEF), a standard measure of left-ventricular function, by radionuclide angiography. Patients were enrolled prospectively. On the basis of clinical findings, conventional tests, and response to specific treatment, 20 of the 52 patients were classified as having primary lung disorder (PLD), 12 as HF alone, and 20 as HF with underlying PLD (HF/PLD). Compared with findings in PLD patients, LVEF was significantly depressed in HF and HF/PLD patients (p < 0·001), whereas both plasma ANP and BNP were significantly increased (p<0 001). Admission plasma BNP concentration more accurately reflected the final diagnosis of HF (93% sensitivity and 90% specificity when BNP ≽ 22 pmol/L) than LVEF or plasma ANP concentration. When all patients were considered together, there were strong negative correlations between LVEF and log BNP (r= - 0·7, p<0·001) and log ANP (r= - 0 59, p<0·001). Our finding that plasma BNP is raised in dyspnoeic patients with HF but not in acutely breathless patients with PLD, suggests that rapid BNP assays may assist in the diagnosis of patients with acute dyspnoea.

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Cited by (486)

  • The value of B-type natriuretic peptide plasma concentrations in very old people with chronic peripheral oedema

    2020, Archives of Cardiovascular Diseases
    Citation Excerpt :

    Recognition of CHF is a major step towards implementing appropriate treatments and improving the prognosis of patients with CPE of cardiac origin. The clinical utility of BNP plasma concentration has been studied extensively in patients with acute dyspnoea, and especially in the context of emergencies [11–13]. A large consensus established that values < 100 pg/mL rule out the diagnosis of heart failure, and that values > 400 pg/mL are a strong argument for this diagnosis [17].

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