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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: Yeganeh, Mojdeh, Jaweed, Syed Saleem, Woei, Kelvin Siew Shenq, Zakaria, Mohd Idzwan, Loch, Alexander
Format: Article
Published: Sage Publications Ltd 2022
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R Medicine
Online Access:http://eprints.um.edu.my/42488/
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spelling my.um.eprints.424882023-10-09T02:06:09Z http://eprints.um.edu.my/42488/ Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea Yeganeh, Mojdeh Jaweed, Syed Saleem Woei, Kelvin Siew Shenq Zakaria, Mohd Idzwan Loch, Alexander R Medicine 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. Sage Publications Ltd 2022-03 Article PeerReviewed Yeganeh, Mojdeh and Jaweed, Syed Saleem and Woei, Kelvin Siew Shenq and Zakaria, Mohd Idzwan and Loch, Alexander (2022) Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea. Hong Kong Journal of Emergency Medicine, 29 (2). pp. 101-107. ISSN 1024-9079, DOI https://doi.org/10.1177/1024907920910623 <https://doi.org/10.1177/1024907920910623>. 10.1177/1024907920910623
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Yeganeh, Mojdeh
Jaweed, Syed Saleem
Woei, Kelvin Siew Shenq
Zakaria, Mohd Idzwan
Loch, Alexander
Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
description 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.
format Article
author Yeganeh, Mojdeh
Jaweed, Syed Saleem
Woei, Kelvin Siew Shenq
Zakaria, Mohd Idzwan
Loch, Alexander
author_facet Yeganeh, Mojdeh
Jaweed, Syed Saleem
Woei, Kelvin Siew Shenq
Zakaria, Mohd Idzwan
Loch, Alexander
author_sort Yeganeh, Mojdeh
title Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
title_short Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
title_full Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
title_fullStr Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
title_full_unstemmed Accuracy of B-type natriuretic peptide in a multiethnic Asian population with acute dyspnea
title_sort accuracy of b-type natriuretic peptide in a multiethnic asian population with acute dyspnea
publisher Sage Publications Ltd
publishDate 2022
url http://eprints.um.edu.my/42488/
_version_ 1781704650728144896
score 13.211869

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