European Journal of Heart Failure Advance Access originally published online on June 10, 2009
European Journal of Heart Failure 2009 11(7):659-667; doi:10.1093/eurjhf/hfp075
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Natriuretic peptides and echocardiography in acute dyspnoea: implication of elevated levels with normal systolic function
1 Division of Cardiology, Department of Medicine, The University of Maryland School of Medicine, G3K63, 22 S. Greene St, Baltimore, MD21201, USA
2 Department of Pathology, The University of Maryland School of Medicine, Baltimore, MD, USA
3 Department of Emergency Medicine, University of California Davis, Sacramento, CA, USA
4 Department of Emergency Medicine, The University of Maryland School of Medicine, Baltimore, MD, USA
* Corresponding author. Tel: +1 410 328 7204, Fax: +1 410 328 1498, Email: cdefilip{at}medicine.umaryland.edu
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Abstract |
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Aims: Previous evaluations of natriuretic peptide (NP) levels in patients with acute dyspnoea presenting to the emergency department (ED) have selected only a minority of patients for echocardiography. We aimed to evaluate the association between NPs and more subtle echocardiographic findings and to assess the potential for NPs to provide additional prognostic information beyond that provided by echocardiography in ‘all-comers’ with acute dyspnoea.
Methods and results: Prospective echocardiograms were performed on 338/412 patients presenting to the ED with acute dyspnoea. B-type natriuretic peptide and NT-proBNP were measured on presentation. Patients were followed-up for 1 year. Decompensated heart failure was diagnosed in 37% of patients and 13% died. The diagnostic accuracy (c-statistic) of BNP and NT-proBNP for identifying LVEF 
40% was 0.88 (P < 0.001) and 0.86 (P < 0.001), respectively. The c-statistics for BNP and NT-proBNP for identifying diastolic dysfunction were 0.67 (P < 0.001) and 0.67 (P < 0.001); but only 0.57 (P = 0.09) and 0.60 (P = 0.02) in patients with LVEF 
50%. Natriuretic peptides, but not LV mass or diastolic parameters, independently predicted mortality at 1 year in all patients and in those with an LVEF 50%.
Conclusion: In an acute dyspnoea population with ‘all-comers’ undergoing echocardiography, NPs correlate strongly with structural abnormalities and identify those with preserved LVEF at highest risk for death. Careful interpretation of elevated NP values is needed in the presence of preserved systolic function.
Key Words: Heart failure • Natriuretic peptides • Echocardiography • Prognosis
Received December 24, 2008; Revised April 2, 2009; Accepted April 6, 2009