"N-Terminal Pro-BNP as a Tool for Acute Heart Failure Diagnosis"
Journal name: The Malaysian Journal of Medical Sciences
Original article title: The Utility of N-Terminal Pro-Brain Natriuretic Peptide as an Adjunct Diagnostic Tool for Acute Heart Failure in Acute Dyspneic Patients Coming to the Emergency Department: A Retrospective Review of Our Early Experience
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Rathika Rajah, Kuan Yee Lim, Boon Hau Ng, Chun Ian Soo
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: The Utility of N-Terminal Pro-Brain Natriuretic Peptide as an Adjunct Diagnostic Tool for Acute Heart Failure in Acute Dyspneic Patients Coming to the Emergency Department: A Retrospective Review of Our Early Experience
Year: 2021 | Doi: 10.21315/mjms2021.28.4.15
Copyright (license): CC BY 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Acute dyspnea is a common reason for hospital admissions, particularly in emergency settings. This condition presents significant challenges for clinicians seeking to make accurate and timely diagnoses. In many public hospitals in Malaysia, the use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a diagnostic tool for acute heart failure (HF) in patients experiencing persistent dyspnea has not been widely adopted. This retrospective study aimed to evaluate the utility of NT-proBNP in conjunction with non-standardized clinical assessments to identify acute HF in a cohort of patients.
The Role of NT-proBNP in Diagnosing Acute Heart Failure
The findings from this retrospective review of 30 patients with acute dyspnea revealed that NT-proBNP was positive in 20 patients diagnosed with acute HF, demonstrating a high sensitivity of 90% and a specificity of 70%. The use of age-stratified cut-off values for NT-proBNP proved effective in differentiating HF from other causes of dyspnea. Notably, three patients with septic shock exhibited false-positive NT-proBNP results despite normal echocardiogram findings, emphasizing the need for caution when interpreting NT-proBNP levels in the context of other medical conditions. This study highlights the importance of using NT-proBNP as a crucial point-of-care test for resolving diagnostic uncertainties in acute dyspneic patients.
Conclusion
The integration of NT-proBNP as an adjunct to clinical evaluations can significantly enhance the diagnosis of acute heart failure, particularly in cases where the clinical presentation is ambiguous. Despite the limitations of this study, such as the small sample size and its retrospective nature, the findings support further incorporation of NT-proBNP testing into routine clinical practice to improve outcomes for patients with acute dyspnea in emergency settings.
FAQ section (important questions/answers):
What is the significance of NT-proBNP in acute dyspnea cases?
NT-proBNP is crucial for identifying acute heart failure (HF) in dyspneic patients, exhibiting 90% sensitivity and helping to differentiate HF from other conditions like pneumonia or chronic obstructive pulmonary disease.
How effective is NT-proBNP in diagnosing acute heart failure?
In the study, NT-proBNP showed a sensitivity of 90% and a specificity of 70%, indicating its effectiveness as an adjunct to clinical evaluation in acute HF diagnosis.
What were the main findings regarding misdiagnosis of heart failure?
The study found that 53% of patients had initial misdiagnoses of acute HF, highlighting the need for improved diagnostic methods, including NT-proBNP testing and echocardiograms.
What factors may lead to false-positive NT-proBNP results?
False-positive results can occur due to conditions like septic shock or chronic kidney disease, necessitating careful interpretation of NT-proBNP levels in the context of the overall clinical picture.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “"N-Terminal Pro-BNP as a Tool for Acute Heart Failure Diagnosis"”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
A 'table' in research contexts typically provides a structured way to present data clearly and concisely. In this paper, tables detail the demographic and clinical findings of patients, allowing for easier comparison of results, such as NT-proBNP levels between heart failure and non-heart failure patients. Tables aid in translating complex information into an understandable format.
2) Study (Studying):
A 'study' refers to a systematic investigation undertaken to explore and understand particular phenomena or issues. The context here relates to a retrospective cohort study aimed at assessing the diagnostic utility of NT-proBNP in identifying acute heart failure among patients presenting with dyspnea. Each study contributes to clinical knowledge and informs practice.
3) Measurement:
'Measurement' pertains to the process of quantifying physical quantities or clinical endpoints. In the context of NT-proBNP, it refers to obtaining numerical values that signify the concentration of this biomarker in patients. Such measurements are essential for diagnosing acute heart failure and guiding treatment decisions.
4) Pride:
'Pride' in this context refers to the 'PRIDE' study, which evaluated the role of N-terminal pro-B-type natriuretic peptide in the diagnosis of patients with dyspnea in emergency departments. This study holds significance as it informs the understanding and clinical use of NT-proBNP and its efficacy in heart failure diagnosis.
5) Sign:
A 'sign' in clinical terms refers to observable evidence of a condition. In this study, signs might include elevated jugular venous pressure or crepitations in lung sounds, which can help clinicians assess heart failure. Recognizing these signs is critical for accurate diagnoses and improving patient management.
6) Disease:
'Disease' pertains to a pathological condition that affects bodily functions. In this research, the primary disease focus is acute heart failure, a serious condition that requires prompt identification and treatment. Understanding different diseases that present with dyspnea helps enhance differential diagnosis and appropriate patient care.
7) Post:
'Post' indicates timing, specifically referring to the period after an event. Here, it denotes 'post-admission' patients who exhibited persistent dyspnea for over 24 hours. This timeframe is crucial as it points to the need for careful assessment and intervention to address potential heart failures in these patients.
8) Quality:
'Quality' often relates to the standard or degree of excellence. In this context, it pertains to the quality of assessments like portable chest X-rays and echocardiograms used in diagnosing acute heart failure. High-quality assessments are vital for accurate diagnosis and proper patient management.
9) Artiga:
'Artiga' refers to a co-author or contributor in the referenced literature. The significance lies in acknowledging contributors to clinical studies, such as research on heart failure diagnosis. Such contributions enrich the body of knowledge and facilitate discussions on improving clinical practices.
10) Edema (Oedema):
'Oedema' denotes the accumulation of fluid in tissues, often associated with heart failure. In patients with dyspnea, the presence of lower limb oedema can be an important clinical sign. Recognizing this condition is vital for correct assessments and appropriate treatment plans.
11) Rules:
'Rules' in clinical practice refer to established guidelines or protocols. In this paper, age-stratified cut-off values for NT-proBNP levels serve as rules for diagnosing acute heart failure. Following these rules enables clinicians to differentiate between heart failure and other causes of dyspnea accurately.
12) Papa:
'Papa' refers to one of the authors cited in the reference section. The contributions from authors like Papa enhance research validity by supporting findings through broader studies, such as guidelines concerning heart failure diagnosis and management. It's crucial for creating a well-rounded literary backdrop.
13) Calculation:
'Calculation' involves quantifying results and interpreting data statistically. In this study, statistical calculations help establish the validity of the NT-proBNP's diagnostic value. Accurate calculations are fundamental for assessing sensitivity, specificity, and predictive values, thereby informing clinical decisions.
14) Performance:
'Performance' relates to the effectiveness of NT-proBNP testing in diagnosing acute heart failure. The study evaluates this performance through metrics like sensitivity and specificity, which are essential to determine how reliably NT-proBNP can predict heart failure in patients presenting with dyspnea.
15) Discussion:
'Discussion' is a critical section in research papers where results are analyzed and interpreted. It often includes implications, limitations, and future directions. Discussing findings from the study offers insights into NT-proBNP utility and highlights areas needing further research, thereby enhancing clinical practice.
16) Training:
'Training' pertains to educational programs for healthcare professionals to ensure they possess the necessary skills to perform diagnostic procedures, including echocardiograms and clinical assessments. Enhanced training improves diagnostic accuracy and supports better patient outcomes in acute heart failure cases.
17) Dealing:
'Dealing' indicates how clinicians manage clinical situations. In this research, it pertains to addressing patients with ambiguous presentations of acute dyspnea, emphasizing the importance of critical thinking and appropriate use of diagnostic tools to improve patient care effectively.
18) Filling (Filled):
'Filling' refers to the condition where fluids accumulate, particularly in blood vessels or myocardial cells. In the context of heart failure, improper filling can lead to fluid overload, resulting in symptoms like dyspnea. Understanding filling pressures is crucial for diagnoses and treatment planning.
19) Reason:
'Reason' signifies the underlying causes or justifications behind clinical decisions or study rationales. In this paper, reasons for investigating NT-proBNP stem from its potential to differentiate acute heart failure from other non-cardiac causes of dyspnea, addressing a vital clinical dilemma.
20) Death:
'Death' pertains to the cessation of life and is a pivotal endpoint in clinical studies evaluating disease severity. Understanding mortality rates associated with heart failure informs risk stratification and emphasizes the need for accurate and timely diagnoses to improve patient prognoses.
21) Male:
'Male' refers to a gender classification used during demographic reporting in clinical studies. The understanding of gender distribution among patients can influence health outcomes and provides insights into varying presentations and management of heart failure, aiding in personalized healthcare strategies.
Other Science Concepts:
Discover the significance of concepts within the article: ‘"N-Terminal Pro-BNP as a Tool for Acute Heart Failure Diagnosis"’. Further sources in the context of Science might help you critically compare this page with similair documents:
Clinical evaluation, Chronic Kidney Disease, Retrospective cohort study, Sensitivity and Specificity, Positive predictive value, Negative predictive value, Acute heart failure, Clinical Audit, False Positive Results.