Top

Published in:

01-12-2004 | Original

Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea

Authors: Patrick Ray, Martine Arthaud, Yannick Lefort, Sophie Birolleau, Catherine Beigelman, Bruno Riou, the EPIDASA Study Group

Published in: Intensive Care Medicine | Issue 12/2004

Abstract

Objective

Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is particularly difficult in elderly patients. The aim of our study was to evaluate B-type natriuretic peptide (BNP) in patients older than 65 years presenting with acute dyspnea.

Design

Prospective study.

Setting

Medical emergency department of a 2000-bed urban teaching hospital.

Patients

Patients aged over 65 years presenting with acute dyspnea and a respiratory rate more than 25/min or a PaO₂ below 70 mmHg, SpO₂less than 92%, PaCO₂ higher than 45 mmHg with pH less than 7.35, were included. BNP levels, measured blind at admission were compared with the final diagnosis (CPE or no CPE) as defined by experts.

Intervention

None.

Measurements and results

Three hundred eight patients (mean age of 80 years) were enrolled in the study. The median BNP was 575 pg/ml [95% confidence interval (CI): 410–898] in the CPE group (n=141) versus 75 pg/ml (95% CI: 59–98) in the no CPE group (n=167) (p<0.001). The best threshold value of BNP was 250 pg/ml, with a sensitivity and specificity for CPE of 0.78 (95% CI: 0.71–0.84) and 0.90 (95% CI: 0.84–0.93), respectively. The area under the ROC curve was 0.874±0.081 (p<0.001). The accuracy of BNP-assisted diagnosis was higher than that of the emergency physician (0.84 versus 0.77, p<0.05).

Conclusion

Analysis of BNP is useful in elderly patients with acute dyspnea, but the threshold value is higher than that previously determined.

Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, Gardin JM, Rutledge JE, Boineau RC (2000) Predictors of congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol 3:1628–1637CrossRef

Lien CT, Gillespie ND, Struthers AD, McMurdo ME (2002) Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 4:91–98CrossRefPubMed

Wuerz RC, Meador SA (1992) Effects of pre hospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 21:669–674PubMed

Brown LH, Gough JE, Seim RH (1998) Can quantitative capnometry differentiate between cardiac and obstructive causes of respiratory distress? Chest 113:323–326PubMed

McNamara RM, Cionni DJ (1992) Utility of the peak expiratory flow rate in the differentiation of acute dyspnea. Cardiac vs pulmonary origin. Chest 101:129–312PubMed

Ailani RK, Ravakhah K, DiGiovine B, Jacobsen G, Tun T, Epstein D, West BC (1999) Dyspnea differentiation index. A new method for the rapid separation of cardiac vs pulmonary dyspnea. Chest 116:1100–1104CrossRefPubMed

Marantz PR, Tobin JN, Derby CA, Cohen MV (1994) Age-associated changes in diastolic filling: Doppler E/A is not associated with congestive heart failure in the elderly. South Med J 87:728–735PubMed

Levin ER, Gardner DG, Samson WK (1998) Natriuretic peptides N Engl J Med 339:321–328CrossRef

Davis M, Espiner E, Richards G, Billings J, Town I, Neill A, Richards M, Turner J, Yandle T (1994) Plasma brain natriuretic peptide in assessment of acute dyspnoea. Lancet 343:440–444CrossRefPubMed

10.

Cabanes L, Richaud-Thiriez B, Fulla Y, Heloire F, Vuillemard C, Weber S, Dusser D (2001) Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea. Chest 120:2047–2050CrossRefPubMed

11.

Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, Clopton P, Alberto J, Hlavin P, Maisel AS (2001) Utility of B-natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 37:379–385CrossRefPubMed

12.

Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A (2002) B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. J Am Coll Cardiol 39:202–209CrossRefPubMed

13.

Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham W, Wu A, Clopton P, Steg G, Westheim A, Wold Knudsen C, Perez A, Kazanegra R, Herrmann H, McCullough P (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167CrossRefPubMed

14.

Clerico A, Del Ry S, Maffei S, Prontera C, Emdin M, Giannessi D (2002) The circulating levels of cardiac natriuretic hormones in healthy adults: effect of age and sex. Clin Chem Lab Med 40:371–377PubMed

15.

Ho KK, Pinsky JL, Kannel WB, Levy D (1993) The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 2:6A-13A

16.

Ray P, Birolleau S, Lefort Y, Beigelman C, Becquemin M-H, Isnard R, Boddaert J, Teixeira A, Riou B (2002) Epidemiological study of acute dyspnea in elderly patients, in an emergency department. The EPIDASA study. Am J Respir Crit Care Med 165:A265

17.

American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152 (Suppl):S77–S120PubMed

18.

Task force report (2000) Guidelines on diagnosis and management of acute pulmonary embolism. Eur Heart J 21:1301–1336CrossRefPubMed

19.

Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat PV, Chavelas C, Zanker C, Bouvier E, Solal AC (2002) Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol 40:1794–1800CrossRefPubMed

20.

Gross JS, Neufeld RR, Libow LS, Gerber I, Rodstein M (1988) Autopsy study of the elderly institutionalized patient. Review of 234 autopsies. Arch Intern Med 14:173–176CrossRef

21.

Hermann PG, Khan A, Kollman CE, Rojas KA, Carnody DP, Bodenheimer M (1990) Limited correlation of left ventricular end diastolic pressure with radiographic assessment of pulmonary hemodynamics. Radiology 174:721–724PubMed

22.

Hood S, Taylor S, Roeves A, Crook AM, Tlusty P, Cohen J, Kaddoura S, Hemingway H (2000) Are there age and sex differences in the investigation and treatment of heart failure? A population-based study. Br J Gen Pract 50:559–563PubMed

23.

Maisel AS, Koon J, Krishnaswamy P, Kazenegra R, Clopton P, Gardetto N, Morrisey R, Garcia A, Chiu A, De Maria A (2001) Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am J Heart 141:367–374CrossRef

24.

Loke I, Squire I, Davies J, Ng L (2003) Reference ranges for natriuretic peptides for diagnostic use are dependent on age, gender and heart rate. Eur J Heart Fail 5:599–606CrossRefPubMed

25.

Lainchbury J, Campbell E, Frampton C, Yandle T, Nicholls M, Richards A (2003) Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol 42:728–735CrossRefPubMed

26.

McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS, Breathing Not Properly Multinational Study Investigators (2003) B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis 41:571–579CrossRefPubMed

27.

Smith H, Pickering RM, Struthers A, Simpson I, Mant D (2000) Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study. BMJ 320:906–908CrossRefPubMed

28.

Wallen T, Landahl S, Hedner T, Nakao K, Saito Y (1997) Brain natriuretic peptide predicts mortality in the elderly. Heart 77:264–267PubMed

29.

Yamada Y, Goto J, Yokota M (1997) Brain natriuretic peptide is a sensitive indicator of impaired left-ventricular function in elderly patients with cardiovascular disease. Cardiology 88:401–407PubMed

30.

Ueda R, Yokouchi M, Suzuki T, Otomo E, Katagiri T (2003) Prognostic value of high plasma brain natriuretic peptide concentrations in very elderly persons. Am J Med 114:266–270CrossRefPubMed

31.

Tamura K, Takahashi N, Nakatani Y, Onishi S, Iwasaka T (2001) Prognostic impact of plasma brain natriuretic peptide for cardiac events in elderly patients with congestive heart failure. Gerontology 47:46–51CrossRefPubMed

32.

Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, Clopton P, Maisel A (2001) A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 37:386–391CrossRefPubMed

33.

McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS (2002) B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 106:416–422CrossRefPubMed

34.

De Denus S, Pharand C, Williamson D (2004) Brain natriuretic peptide in the management of heart failure: the versatile neurohormone. Chest 125:652–668CrossRefPubMed

35.

Fischer JE, Bachmann LM, Jaeschke R (2003) A readers’ guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Med 7:1043–1051CrossRef

Title: Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea
Authors: Patrick Ray
Martine Arthaud
Yannick Lefort
Sophie Birolleau
Catherine Beigelman
Bruno Riou
the EPIDASA Study Group
Publication date: 01-12-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2469-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea

Abstract

Objective

Design

Setting

Patients

Intervention

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Intervention

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2004

Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey

Tissue capnometry: does the answer lie under the tongue?

Influence of positive end-expiratory pressure (PEEP) on histopathological and bacteriological aspects of pneumonia during low tidal volume mechanical ventilation

Reasons for the higher incidence of unplanned extubation in medical ICUs than in surgical ICUs: reply to the letter by F. Kapadia

Therapeutic hypothermia following cardiac arrest: class I evidence?

Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects