Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure

• Published in: The American journal of cardiology Vol. 93; no. 9; pp. 1130 - 1135
• Main Authors: Dokainish, Hisham, Zoghbi, William A, Lakkis, Nasser M, Quinones, Miguel A, Nagueh, Sherif F
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2004; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Blood Flow Velocity - physiology; Cardiology. Vascular system; Echocardiography, Doppler; Female; Heart; Heart Atria - diagnostic imaging; Heart failure; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - physiopathology; Natriuretic Peptide, Brain - blood; Patients; Peptides; Predictive Value of Tests; Sensitivity and Specificity; Stroke Volume - physiology; Texas; Tissues; Ultrasonic imaging; Ventricular Pressure - physiology; Sonography; Heart failure; Peptides; Cardiovascular disease; Duplex ultrasonography; Phlebology; Tissue; Accuracy; Type; Heart disease; Medical imagery; Circulatory system; Diagnosis; Cardiology; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2004.01.042

B-type natriuretic peptide (BNP) and early diastolic transmitral velocity/tissue Doppler mitral annular velocity (E/Ea) both estimate left ventricular filling pressure, but have not been compared in the diagnosis of congestive heart failure (CHF). One hundred twenty-two hospital inpatients with suspected CHF underwent simultaneous clinical examination, BNP measurement, and comprehensive echo-Doppler examination. The accuracy of BNP and echocardiography was compared with the Framingham criteria diagnosis of CHF. Seventy patients (57%) had clinical CHF, whereas 52 (43%) did not. In all patients, the optimal BNP cutoff was >250 pg/ml (sensitivity 86%, specificity 77%). E/Ea >15 had 83% sensitivity and 82% specificity, whereas comprehensive echo-Doppler had 95% sensitivity and 88% specificity for CHF. In patients with normal ejection fraction, the optimal BNP cutoff was >150 pg/ml (sensitivity 79%, specificity 85%). E/Ea >15 had 79% sensitivity and 93% specificity, whereas comprehensive echo-Doppler had 85% sensitivity and 96% specificity for CHF. In patients with reduced ejection fraction, the optimal BNP cutoff was >300 pg/ml (sensitivity 88%, specificity 60%). E/Ea >15 had 92% sensitivity and 72% specificity, whereas comprehensive echo-Doppler had 96% sensitivity and 80% specificity (p = 0.08 compared with BNP) for CHF. Overall, BNP and E/Ea have similar diagnostic accuracy for CHF in this patient population. In patients with reduced ejection fraction, comprehensive echo-Doppler trended toward higher specificity than BNP for clinical CHF.