Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
Background: Optimal cut-offs for B-type natriuretic peptide (BNP) for the diagnosis of heart failure differ based on ethnicity. There are no data for Southeast Asian patients. We aimed to define the optimal cut-off points and the strength of B-type natriuretic peptide as a predictor of heart failure...
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| Main Authors: | , , , , |
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| Format: | Article |
| Published: |
Sage Publications Ltd
2022
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| Subjects: | |
| Online Access: | http://eprints.um.edu.my/42488/ |
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| Summary: | Background: Optimal cut-offs for B-type natriuretic peptide (BNP) for the diagnosis of heart failure differ based on ethnicity. There are no data for Southeast Asian patients. We aimed to define the optimal cut-off points and the strength of B-type natriuretic peptide as a predictor of heart failure in Southeast Asian multiethnic population. Methods: Bedside B-type natriuretic peptide (SOB panel (Biosite (R))) was measured for patients (>50 years) presenting with dyspnea. Emergency physicians (blinded to B-type natriuretic peptide result) assessed the probability of acute heart failure on a scale of 0%-100%. Heart failure diagnosis was adjudicated by two cardiologists. Results: In all, 43% (n = 87) of the 203 dyspneic patients (54.7% males, 453% females) had a final diagnosis of acute heart failure. B-type natriuretic peptide values ranged from 3.2 to 4960 pg/mL (median, 189 pg/mL). Median B-type natriuretic peptide values of patients with the final diagnosis of ``acute heart failure,'' ``no acute heart failure but history of heart failure,'' and ``no heart failure'' were 600, 301, and 68 pg/mL, respectively. The optimum cut-off was 186 pg/mL. The receiver operating characteristic curve of the emergency physician's assessment of the probability of heart failure based on clinical assessment had an area under the curve of 85% (95% confidence interval: 80%-90%). Combining receiver operating characteristic curves of physician assessment and B-type natriuretic peptide values yielded an area under the curve of 96% (95% confidence interval: 93%-98%). B-type natriuretic peptide levels less than 100 pg/mL were the strongest predictor of heart failure (odds ratio: 26.36; confidence interval: 6.85-101.41), followed by upper lobe diversion and cardiomegaly. Conclusion: The accuracy of bedside B-type natriuretic peptide was validated in a multiethnic Asian population. Optimum cut-off is 186 pg/mL. A B-type natriuretic peptide >100 pg/mL is the single strongest independent predictor of heart failure. |
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