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

Research output: Contribution to journalArticlepeer-review

946 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
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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