Annals of Emergency Medicine
Volume 45, Issue 6 , Pages 573-580, June 2005

Predictors of Elevated B-Type Natriuretic Peptide Concentrations in Dyspneic Patients Without Heart Failure: An Analysis From the Breathing Not Properly Multinational Study

From the University of California, San Diego, Veteran's Affairs Medical Center, San Diego, CA (Maisel, Clopton); Henry Ford Hospital, Detroit, MI (Nowak, McCord); University of Pennsylvania, Philadelphia, PA (Hollander); Hopital Bichat, Paris, France (Duc); Ullevål University Hospital, Oslo, Norway (Westheim, Klemsdal, Knudsen); University of Oslo, Akershus University Hospital, Lørenskog, Norway (Omland); University of Cincinnati College of Medicine, Cincinnati, OH (Storrow); University of Kentucky College of Medicine, Lexington, KY (Abraham); Hartford Hospital, Hartford, CT (Wu); and the William Beaumont Hospital, Royal Oak, MI (McCullough)

Received 25 August 2004; received in revised form 30 November 2004; accepted 17 January 2005. published online 18 April 2005.

Study objective

B-type natriuretic peptide (BNP) is an established tool for the diagnosis of acute congestive heart failure in patients presenting with dyspnea. Some patients have moderately elevated BNP levels (ie, 100 to 500 pg/mL) in the absence of acute congestive heart failure. The objective of the current study was to identify independent predictors of elevated BNP concentrations in the absence of congestive heart failure.

Methods

We studied 781 patients without acute congestive heart failure and BNP levels 0 to 500 pg/mL drawn from a cohort of 1,586 patients with acute dyspnea who had BNP levels measured on emergency department arrival. Two cardiologists blinded to BNP results reviewed all clinical data and categorized patients according to whether they had acute congestive heart failure or not.

Results

Independent predictors of elevated BNP levels (ie, >100 pg/mL) were a medical history of atrial fibrillation, radiographic cardiomegaly, decreased blood hemoglobin concentration, decreased body mass index, and increased age.

Conclusion

Knowledge of these commonly obtained variables should aid clinicians in the interpretation of moderately elevated BNP results in patients presenting with acute dyspnea in the emergency department.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Author contributions: CWK, PC, AHBW, PD, JM, RMN, JEH, ABS, WTA, PMC, AM, and TO conceived and designed the study. JEH and ABS obtained funding, and AHBW, RMN, and WTA provided administrative/technical support. CWK, AHBW, PD, RMN, JEH, ABS, WTA, PMC, and AM participated in data acquisition. CWK, PC, AW, TOK, RMN, JEH, AM, and TO participated in data analysis and interpretation of data. CWK and TO drafted the manuscript. CWK, PC, and TO provided statistical expertise. PC, AW, TOK, AHBW, JM, RMN, JEH, ABS, WTA, PMC, AM, and TO critically revised the manuscript. TO and CWK take responsibility for the paper as a whole.Funding and support: Triage BNP devices and meters and some financial support were provided by Biosite, Inc., San Diego, CA. The following authors have received honoraria from the manufacturer of the BNP assay used in the study: Maisel, Clopton, Nowak, McCord, Hollander, Duc, Omland, Abraham, Wu, and McCullough.

PII: S0196-0644(05)00134-4

doi:10.1016/j.annemergmed.2005.01.027

Annals of Emergency Medicine
Volume 45, Issue 6 , Pages 573-580, June 2005

Article Tools

* Image Usage & Resolution