Plasma amino-terminal pro-brain natriuretic peptide levels in subjects presenting to the Emergency Department with suspected acute coronary syndrome: possible role in selecting patients for follow up?

被引:14
作者
Campbell, DJ
Munir, V
Hennessy, OF
Dent, AW
机构
[1] St Vincents Hosp, Emergency Dept, Melbourne, Vic, Australia
[2] St Vincents Hosp, Dept Med Imaging, Melbourne, Vic, Australia
[3] St Vincents Inst Med Res, Melbourne, Vic, Australia
关键词
acute coronary syndrome; BNP; heart failure; natriuretic peptide;
D O I
10.1046/j.1445-5994.2001.00042.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) level is a sensitive and specific indicator of cardiac dysfunction. Aim: To determine whether plasma NT-proBNP level is elevated at the time of presentation with acute coronary syndrome (ACS) and whether it may assist in the diagnosis of heart failure and myocardial ischaemia in the Emergency Department. Methods: Plasma NT-proBNP levels were measured prospectively in 201 unselected presentations to the Emergency Department with suspected ACS where cardiac injury markers were requested by clinicians as part of routine assessment. NT-proBNP levels were correlated with clinical, electrocardiogram (ECG), biochemical and radiological findings. Results: Elevated NT-proBNP level detected heart failure with high sensitivity (95-96%). Among patients without heart failure, NT-proBNP levels were increased more frequently in patients with previously diagnosed ischaemic heart disease. Elevated NT-proBNP level predicted cardiomegaly and a cardiac cause of presentation. However, the NT-proBNP level was not associated with ECG or biochemical markers of myocardial ischaemia, and only one-third of patients with ACS showed an increase of 30% or more in NT-proBNP level at repeat measurement of cardiac injury markers 5 h after presentation Conclusions: Although elevated NT-proBNP level detected heart failure with high sensitivity, NT-proBNP level did not assist in the diagnosis of acute myocardial ischaemia. These findings indicate that the major determinant of elevated NT-proBNP level on presentation with suspected ACS was underlying cardiac dysfunction rather than acute myocardial ischaemia. This suggests that NT-proBNP measurement in patients with a suspected cardiac reason for presentation to the Emergency Department may identify a previously unrecognized group of patients without acute ischaemia who may nevertheless benefit from further investigation of cardiac function.
引用
收藏
页码:211 / 219
页数:9
相关论文
共 31 条
[1]   Plasma brain natriuretic peptide concentrations predict survival after acute myocardial infarction [J].
Arakawa, N ;
Nakamura, M ;
Aoki, H ;
Hiramori, K .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 27 (07) :1656-1661
[2]  
ARONEY C, 2000, MED J AUST S, V173, pS65
[3]   Management of acute coronary syndromes:: acute coronary syndromes without persistent ST segment elevation -: Recommendations of the Task Force of the European Society of Cardiology [J].
Bertrand, ME ;
Simoons, ML ;
Fox, KAA ;
Wallentin, LC ;
Hamm, CW ;
McFadden, E ;
De Feyter, PJ ;
Specchia, G ;
Ruzyllo, W .
EUROPEAN HEART JOURNAL, 2000, 21 (17) :1406-1432
[4]   Plasma amino-terminal pro-brain natriuretic peptide: A novel approach to the diagnosis of cardiac dysfunction [J].
Campbell, DJ ;
Mitchelhill, KI ;
Schlicht, SM ;
Booth, RJ .
JOURNAL OF CARDIAC FAILURE, 2000, 6 (02) :130-139
[5]   Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain [J].
Canto, JG ;
Shlipak, MG ;
Rogers, WJ ;
Malmgren, JA ;
Frederick, PD ;
Lambrew, CT ;
Ornato, JP ;
Barron, HV ;
Kiefe, CI .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (24) :3223-3229
[6]   EFFECT OF VASODILATOR THERAPY ON MORTALITY IN CHRONIC CONGESTIVE-HEART-FAILURE - RESULTS OF A VETERANS-ADMINISTRATION COOPERATIVE STUDY [J].
COHN, JN ;
ARCHIBALD, DG ;
ZIESCHE, S ;
FRANCIOSA, JA ;
HARSTON, WE ;
TRISTANI, FE ;
DUNKMAN, WB ;
JACOBS, W ;
FRANCIS, GS ;
FLOHR, KH ;
GOLDMAN, S ;
COBB, FR ;
SHAH, PM ;
SAUNDERS, R ;
FLETCHER, RD ;
LOEB, HS ;
HUGHES, VC ;
BAKER, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (24) :1547-1552
[7]   A COMPARISON OF ENALAPRIL WITH HYDRALAZINE ISOSORBIDE DINITRATE IN THE TREATMENT OF CHRONIC CONGESTIVE-HEART-FAILURE [J].
COHN, JN ;
JOHNSON, G ;
ZIESCHE, S ;
COBB, F ;
FRANCIS, G ;
TRISTANI, F ;
SMITH, R ;
DUNKMAN, WB ;
LOEB, H ;
WONG, ML ;
BHAT, G ;
GOLDMAN, S ;
FLETCHER, RD ;
DOHERTY, J ;
HUGHES, CV ;
CARSON, P ;
CINTRON, G ;
SHABETAI, R ;
HAAKENSON, C .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (05) :303-310
[8]   Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care [J].
Cowie, MR ;
Struthers, AD ;
Wood, DA ;
Coats, AJS ;
Thompson, SG ;
PooleWilson, PA ;
Sutton, GC .
LANCET, 1997, 350 (9088) :1349-1353
[9]   PLASMA BRAIN NATRIURETIC PEPTIDE IN ASSESSMENT OF ACUTE DYSPNEA [J].
DAVIS, M ;
ESPINER, E ;
RICHARDS, G ;
BILLINGS, J ;
TOWN, I ;
NEILL, A ;
DRENNAN, C ;
RICHARDS, M ;
TURNER, J ;
YANDLE, T .
LANCET, 1994, 343 (8895) :440-444
[10]   ACUTE CHANGES IN ATRIAL-NATRIURETIC-PEPTIDE, INSULIN-LIKE GROWTH-FACTOR-I, AND LACTATE LEVELS DURING LEFT ANTERIOR DESCENDING CORONARY-ARTERY ANGIOPLASTY [J].
GILL, JS ;
PRASAD, K ;
STEWART, JT ;
PUMPHREY, CW ;
HOLT, DW ;
MCKENNA, WJ ;
CAMM, AJ .
AMERICAN HEART JOURNAL, 1995, 130 (04) :717-722