• 作者：José ; M. Verdú ; ^a ; ^b ; ^{verdujm@gmail.com} ; Josep Comí ; n-Colet^b ; ^c ; Mar Domingo^d ; ^e ; Josep Lupó ; n^b ; ^f ; Miguel Gó ; mez^b ; ^g ; Luis Molina^b ; ^g ; Jose M. Casacuberta^a ; Miguel A. Muñ ; oz^b ; ^h ; Amparo Menaⁱ ; Jordi Bruguera-Cortada^g
• 关键词：ECG ; electrocardiograma ; FEVI ; fracció ; n de eyecció ; n del ventrí ; culo izquierdo ; IC ; insuficiencia cardiaca ; NT-proBNP ; fracció ; n N-terminal del pé ; ptido natriuré ; tico tipo B ; ROC ; receiver operating characteristic
• 刊名：Revista Espa?ola de Cardiolog篓陋a
• 出版年：2012
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：July, 2012
• 卷：65
• 期：7
• 页码：613-619
• 文件大小：263 K

Introduction and objectives

Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care.

Methods

Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data).

Results

Of 220 patients evaluated (65.5%women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50%(39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715聽pg/mL [interquartile range 510.5-1575] and 77.5聽pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95%confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67%of requested echocardiograms.

Conclusions

In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnosys and could be cost-effectiveness.

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