Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?
Authors: Hans-Gerhard Schneider
Journal: Annals of Internal Medicine (2009)

Letters18 August 2009Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?Hans-Gerhard Schneider, MBBS, MD, Louisa Lam, MPH, and Peter Cameron, MBBS, MDHans-Gerhard Schneider, MBBS, MDFrom Alfred Pathology Service, Alfred Health, Prahran, Victoria 3181, Australia, and Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia.Search for more papers by this author, Louisa Lam, MPHFrom Alfred Pathology Service, Alfred Health, Prahran, Victoria 3181, Australia, and Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia.Search for more papers by this author, and Peter Cameron, MBBS, MDFrom Alfred Pathology Service, Alfred Health, Prahran, Victoria 3181, Australia, and Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the responses to our article. Dr. Tapolyai asks whether the emergency department physicians ignored the BNP results, which provide “clear, objective, laboratory-proven evidence.” Levels of BNP are elevated in a range of conditions other than heart failure, such as pulmonary embolism, acute coronary syndromes, and acute myocardial infarction, and increase with atrial fibrillation, radiographic cardiomegaly, decreased blood hemoglobin concentration, decreased body mass index, and increasing age (1). Our population was older than the populations in some other studies. The diagnostic accuracy of our physicians was 80.5% overall. In the Breathing Not Properly study (2), clinicians had ...References1. Knudsen CW, Clopton P, Westheim A, Klemsdal TO, Wu AH, Duc P, et al. Predictors of elevated B-type natriuretic peptide concentrations in dyspneic patients without heart failure: an analysis from the breathing not properly multinational study. Ann Emerg Med. 2005;45:573-80. [PMID: 15940086] CrossrefMedlineGoogle Scholar2. McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106:416-22. [PMID: 12135939] CrossrefMedlineGoogle Scholar3. Januzzi JL, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, Krauser DG, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005;95:948-54. [PMID: 15820160] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Alfred Pathology Service, Alfred Health, Prahran, Victoria 3181, Australia, and Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoB-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea Hans-Gerhard Schneider , Louisa Lam , Amaali Lokuge , Henry Krum , Matthew T. Naughton , Pieter De Villiers Smit , Adam Bystrzycki , David Eccleston , Jacob Federman , Genevieve Flannery , and Peter Cameron Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Mihály Tapolyai Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Ajay Pachika , Malek Numeir , and Kiranmayi Adimoolam Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Franca Dipaola , Francesca Perego , Monica Solbiati , Giovanni Casazza , and Metrics 18 August 2009Volume 151, Issue 4Page: 289-290KeywordsBrain natriuretic peptidesDyspneaHeart failureLongitudinal studiesNoninvasive ventilationPulmonary embolismResearch laboratoriesSpecificity ePublished: 18 August 2009 Issue Published: 18 August 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...