| 장귀련, 이주환, 류현민, 이장훈, 양동헌, 박헌식, 조용근, 채성철, 전재은, 박의현 |
Background and Objectives: N-terminal pro-brain natriuretic peptide (NT-proBNP) has been identified as a useful biomarker for heart failure (HF). The aim of this study was to determine the optimal cutpoint of NT-proBNP for diagnosis of HF in patients with dyspnea and to evaluate the relation of NT-proBNP to outcome in patients with HF. Methods: Between January 2006 and August 2006, a total of 526 consecutive patients visiting emergency service with dyspnea were retrospectively included in the study. Patients with acute coronary syndrome and renal insufficiency were excluded. HF was diagnosed according to clinical data and echocardiographic findings. Results: Of the 526 patients (mean age 61.7±14.2 years, 53.4% male), 234 (44.5%) fulfilled the diagnosis of HF. The baseline levels of NT-proBNP were considerably higher in patients with HF (4611±6861 vs 297±562 pg/mL, p <0.0001). The levels of NT-proBNP positively correlated with the severity of HF symptom classified by NYHA functional class (II: 538±1167, III: 4299±5498, IV: 11307±10895 pg/mL, p<0.0001) and negatively correlated with left ventricular ejection fraction (r=0.419, p=0.027) in patients with HF. The area under the receiver operating characteristic curve for the diagnosis of HF was 0.94 (95% CI, 0.92-0.96) and the optimal cutpoint was 530 pg/mL, which yielded 88% sensitivity, 86% specificity, 83.4% positive predictive value and 90% negative predictive value. A cut point of 200 pg/mL had 97.4% negative predictive value to exclude HF. The overall in-hospital mortality in the patients with HF was 7 (3%) out of 234 patients. The baseline NT-proBNP levels were higher in the dead than the survivors (14227±13901 vs 4314±6360, p=0.014). In multivariate analysis, the NT-proBNP was an independent predictor of in-hospital mortality (odds ratio 6.68, 95% CI 100-100.1, p=0.01). Conclusions: NT-proBNP is valuable for indentification and exclusion of HF in dyspneic patients and higher NT-proBNP levels are an independent predictor of in-hospital mortality in patients with HF.
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