Rapid diagnosis of acute dyspnea using the combined test of NT-pro-BNP and left ventricular ejection fraction / 中国综合临床

Objective To investigate the value of N-termind pro-B-type natriuretic peptide(NT-pro-BNP)in differential diagnosis of dyspnea in emergency department, and to investigate the rapid diagnosis cutoff of dyspnea due to acute congestive heart failure. Methods Ninety. one cases of dyspnea in emergency department recruited from January to June ,2008 were divided into two groups: acute cardiac dyspnea group and none acute cardiac dyspnea group. To evaluate the value of different parameters in differential diagnosis of dyspnea in emergency department and analysis the area under the receiver-operating characteristic of different parameters for the diagnosis of acute cardiac dyspnea. To achieve the best cutoff of different parameters for the diagnosis of dyspnea due to acute congestive heart failure finally. Results Among two groups, NT-pro-BNP (acute cardiac dyspnea vs. none acute cardiac dyspnea,6203.50 ng/L vs. 1410.00 ng/L,P ＜ 0.01), Troponin Ⅰ (acute cardiac dyspnea vs. none acute cardiac dyspnea,0.12 μg/L vs. 0.03 μg/L,P ＜0.01) ,left ventricular ejection fraction(acute cardiac dyspnea vs. none acute cardiac dyspnea,46.25% vs. 65.60%, P ＜ 0.01), left atrial diameter (acute cardiac dyspnea vs. none acute cardiac dyspnea,42.75 mm vs. 36.00 mm,P ＜0.01) had significant difference. NT-pro-BNP at cutoff of ≥3715 ng/L was highly sensitive and specific for the diagnosis of acute cardiac dyspnea. Receiver-operating characteristic analyses demonstrated that NT-pro-BNP and left ventricular ejection fraction was the best diagnostic indices of acute cardiac dyspnea. The area under the receiver-operating characteristic curve of Nt-pro-BNP was 0.828 ± 0.045 (P ＜ 0.01),and left ventricular ejection fraction was 0.829 ± 0.049 (P ＜ 0.01). Correlation analysis showed that NT-pro-BNP was correlated with left ventricular ejection fraction (P ＜ 0.01). The combined test of NT-pro-BNP and left ventricular ejection fraction was performed. Specificity increased to 96.50%, total consistent rate increased to 83.50% ,positive predictive value increased to 91.30%, positive likelihood ratio 17.60, faulse diagnostic rate decreased to 3.50%. Conclusions NT-pro-BNP examination in emergency department was helpful to rapid differential diagnosis of dyspnea. It helped to differentiate the patients with acute congestive heart failure and none acute congestive heart failure causes of dyspnea.

Combining Tissue Doppler Echocardiography and Lung Rockets Sign in the Differential Diagnosis of Acute Dyspnea

PURPOSE: We tried (1) to determine the discriminating ability of lung rockets sign in lung ultrasound and E/Ea (the ratio of peak early diastolic mitral inflow velocity to peak early mitral annular velocity measured by tissue Doppler echocardiography) known as an indicator of pulmonary edema in acute dyspnea and (2) to develop a new algorithm using two variables. METHODS: This prospective observational study was performed in an urban emergency department. For the patient with dyspnea at rest, we performed bedside emergency ultrasound assessing the presence of lung rockets sign and measuring the E/Ea. Patients were divided into two groups depending on the cause of dyspnea: pulmonary edema or other cause. We compared the two variables and developed an algorithm using decision tree analysis. RESULTS: A total of 66 patients (39 pulmonary edema, 27 other causes) were enrolled. By univariate analyses, there were significant differences between the two groups in the presence of lung rockets sign (p 13.27 had 100% specificity and positive predictive value for pulmonary edema. CONCLUSION: Lung rockets sign in lung ultrasound and measurement of E/Ea could be helpful in the differential diagnosis of shortness of breath quickly and easily in ED.

B-type Natriuretic Peptide in Differentiating Acute Dyspnea

PURPOSE: This study was to test the diagnostic value of Btype natriuretic peptide (BNP) for differentiating between the causes of acute dyspnea. METHODS: We conducted a prospective study of 41 patients who came to the emergency department with acute dyspnea between August 1, 2002, and October 31, 2002. Plasma BNP was measured for a bedside assay. We excluded patients who suffered from dyspnea due to airway obstruction, hyperventilation syndrome, psychiatric causes, drug intoxication, and chronic renal failure or from dyspnea of neuromuscular origin. The clinical diagnosis of congestive heart failure was adjudicated by echocardiographic findings. Two emergency physicians, who were blinded to the results of the BNP assay and the echocardiographic findings, determined the cause of dyspnea as regard to the Framingham criteria. RESULTS: The final diagnosis of dyspnea was due to a cardiogenic origin in 29 patients (71%), and due to a noncardiogenic origin in 12 patients (29%). The plasma BNP levels in themselves were more specific and sensitive in diagnosing cardiogenic dyspnea than was a clinical decision based on the authority of the Framingham criteria. In the echocardiographic findings, the left-ventricular end-systolic dimension and the left- ventricular end-diastolic dimension were positively correlated with the plasma BNP levels(R=0.44, p=0.002 and R=0.40, p=0.005), the ejection fraction was negatively correlated (R=-0.46, p=0.001). In the multiple logistic-regression analysis, measurements of the plasma BNP level added significant independent predictive power to other clinical variables in the models. CONCLUSION: The assay of plasma BNP in the emergency department was useful method for differentiating acute dyspnea based on its cause, and the plasma BNP level was corresponded to the degree of left ventricular dysfunction.