The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study

James L. Januzzi*, Carlos A. Camargo, Saif Anwaruddin, Aaron L. Baggish, Annabel A. Chen, Daniel G. Krauser, Roderick Tung, Renee Cameron, J. Tobias Nagurney, Claudia U. Chae, Donald M. Lloyd-Jones, David F. Brown, Stacy Foran-Melanson, Patrick M. Sluss, Elizabeth Lee-Lewandrowski, Kent B. Lewandrowski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

890 Scopus citations

Abstract

The utility of aminoterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department to rule out acute congestive heart failure (CHF) and the optimal cutpoints for this use are not established. We conducted a prospective study of 600 patients who presented in the emergency department with dyspnea. The clinical diagnosis of acute CHF was determined by study physicians who were blinded to NT-proBNP results. The primary end point was a comparison of NT-proBNP results with the clinical assessment of the managing physician for identifying acute CHF. The median NT-proBNP level among 209 patients (35%) who had acute CHF was 4,054 versus 131 pg/ml among 390 patients (65%) who did not (p <0.001). NT-proBNP at cutpoints of >450 pg/ml for patients <50 years of age and >900 pg/ml for patients <50 years of age were highly sensitive and specific for the diagnosis of acute CHF (p <0.001). An NT-proBNP level <300 pg/ml was optimal for ruling out acute CHF, with a negative predictive value of 99%. Increased NT-proBNP was the strongest independent predictor of a final diagnosis of acute CHF (odds ratio 44, 95% confidence interval 21.0 to 91.0, p <0.0001). NT-proBNP testing alone was superior to clinical judgment alone for diagnosing acute CHF (p = 0.006); NT-proBNP plus clinical judgment was superior to NT-proBNP or clinical judgment alone. NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting.

Original languageEnglish (US)
Pages (from-to)948-954
Number of pages7
JournalAmerican Journal of Cardiology
Volume95
Issue number8
DOIs
StatePublished - Apr 15 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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