研究顯示:NT-proBNP檢測於急性心衰竭診斷中的關鍵作用

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ICON-RELOADED研究探討了NT-proBNP在急診部急性心衰竭診斷中的效能。此研究包括19個北美急診部的1461名呼吸困難患者,277名(19%)被診斷為急性心衰竭。研究發現,針對不同年齡層的NT-proBNP截止值(450、900、1800 pg/ml)具有高度診斷價值。低於300 pg/ml的NT-proBNP強烈排除急性心衰竭的可能性。該研究為急性心衰竭的快速診斷提供了重要參考,有助於提高臨床判斷的準確性。

急診部的N末端前體B型利尿肽:ICON-RELOADED研究

N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study

Januzzi JL Jr, Chen-Tournoux AA, Christenson RH, Doros G, Hollander JE, Levy PD, Nagurney JT, Nowak RM, Pang PS, Patel D, Peacock WF, Rivers EJ, Walters EL, Gaggin HK; ICON-RELOADED Investigators. N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study. J Am Coll Cardiol. 2018 Mar 20;71(11):1191-1200. doi: 10.1016/j.jacc.2018.01.021. PMID: 29544601.

https://pubmed.ncbi.nlm.nih.gov/29544601/

Abstract

Background

Contemporary reconsideration of diagnostic N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed.

Objectives

This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting.

Methods

Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (-) likelihood ratios (LRs) for acute HF.

Results

Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR- was 0.09 (95% CI: 0.05 to 0.13).

Conclusions

In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF.

Keywords

NT-proBNP; acute heart failure; biomarker; diagnosis; prognosis.

摘要

背景

當前需要重新考慮用於診斷心力衰竭(HF)的N末端前體B型利尿肽(NT-proBNP)診斷閾值。

目標

本研究旨在評估急診部(ED)環境中因呼吸困難就診的患者急性HF的NT-proBNP診斷性能。

方法

在北美的19個ED中,為出現呼吸困難的患者招募並採血,隨後進行NT-proBNP測量。主要終點是年齡分層切點(450、900和1,800 pg/ml)的陽性預測值,用於診斷急性HF,以及排除急性HF的排除切點的陰性預測值。次要終點包括急性HF的敏感性、特異性,以及陽性(+)和陰性(-)似然比(LRs)。

結果

在1461名受試者中,有277人(19%)被確診為急性HF。急性HF診斷的接收者操作特徵曲線下面積為0.91(95%信賴區間[CI]:0.90至0.93;p < 0.001)。年齡分層切點450、900和1,800 pg/ml的敏感性分別為85.7%、79.3%和75.9%;特異性分別為93.9%、84.0%和75.0%。陽性預測值分別為53.6%、58.4%和62.0%。整體LR+跨越年齡依賴切點為5.99(95% CI:5.05至6.93);年齡依賴切點的個別LR+分別為14.08、4.95和3.03。排除切點300 pg/ml的敏感性和陰性預測值分別為93.9%和98.0%;LR-為0.09(95% CI:0.05至0.13)。

結論

在急診部環境中看到的急性呼吸困難患者中,年齡分層的NT-proBNP切點可能有助於診斷急性HF。NT-proBNP <300 pg/ml強烈排除急性HF的存在。

關鍵詞

NT-proBNP;急性心力衰竭;生物標誌物;診斷;預後。