N‐terminal pro‐brain natriuretic peptide for discriminating between cardiac and non‐cardiac dyspnoea

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Abstract
Aim: Evaluation of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) to confirm or disprove heart failure in community patients complaining of dyspnoea.Methods and results: General practitioners referred 345 consecutive patients complaining of dyspnoea to our hospital‐based clinic, where a diagnosis was established based on a combined programme for heart and lung diseases including echocardiography. The level of NT‐proBNP in plasma was also measured. The mean (S.D.) concentration of NT‐proBNP in patients with heart failure was significantly higher, 189 (270) pmol/l in patients with heart failure (n=81), than in patients with non‐cardiac dyspnoea (n=264), 17 (38) pmol/l (P<0.001). In patients ≥50 years NT‐proBNP <11 pmol/l for men and <17 pmol/l for women excluded heart failure with a negative predictive value of 97% while the positive predictive value was 53%, the sensitivity 95% and the specificity 68%. Areas under receiver operator characteristic curves for men and women were 0.93 and 0.90, respectively.Conclusion: In a relevant setting of primary care patients complaining of dyspnoea, NT‐proBNP seems promising for disproval of heart failure, and this test may reduce the need for echocardiographic screening with 50%. However, the discrimination levels of NT‐proBNP found in this study may need prospective confirmation, before the test can be generally recommended.