The Clinical Experiences of B-type Natriuretic Peptide Blood Concentrations for Diagnosis in Congestive Heart Failure : The Single Hospital Experience Based on the Large Clinical Database

ABSTRACT

BACKGROUND: B-type natriuretic peptide (BNP) has been used as a standard diagnostic tool to define heart failure. The aim of this study was to evaluate the clinical experiences of BNP levels based on a large clinical database. METHODS: From Oct. 2002 to July 2003, 3830 patients were analyzed. The patients were divided into the 3 groups: control, systolic (SHF) and diastolic heart failure (DHF) patient groups, via an echocardiography and the Framingham clinical criteria. The BNP was measured with a Triage(R) kit. Both the clinical and echocardiography profiles were analyzed. RESULTS: The mean age of the patients was 62.8 years, with 49.0% males. The control group included 661, the SHF group 475 and the DHF group 287 patients. In the control group, the mean BNP level was 31.5+/-24.0 pg/mL, with the BNP level in the women higher than in the men (28.0+/-23.8 vs. 34.9+/-23.7 pg/mL, p=0.041). The SHF patients group had significantly higher BNP levels than the other groups (p=0.008). In the patients with SHF, the BNP levels, according to the NYHA grade, showed significant differences (I: 169.3+/-138.7, II: 391.1+/-231.4, III: 780.1+/-698.3 and IV: 1078.9+/-946.2 pg/mL, p=0.009). In the patients with diastolic dysfunction (n=787) according to the diastolic dysfunction, the BNP levels, showed significant differences (relaxation abnormality: 108.2+/-78.2, pseudo-normal: 419.0+/-109.8 and restrictive physiology: 510.4+/-231.6 pg/mL, p=0.009). The accuracy in the BNP level when separating the SHF from the control patients was 0.98 (AUC=0.98), with 92.5% sensifivity and 86.1% specificity at a cut-off of 108 pg/mL. CONCLUSIONS: The levels of blood BNP were present in various ranges according to the clinical situation and extent of heart failure.