发布日期：2006年2月
英文标题：NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study.
作者：Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M.
出处：Eur Heart J. 2006 Feb;27(3):330-7.
内容介绍：NT-proBNP检测用于怀疑或确诊为急性心衰的呼吸困难患者的诊断评估和短期预后评估是有价值的。NT-proBNP最佳的心衰排除截定点是300pg/ml，使用年龄分层的 NT-proBNP“纳入”截定点可提高心衰诊断的准确性。NT-proBNP＞5180 ng/L时，强烈提示心衰患者未来76天的死亡风险高。
摘要展示：
AIMS:
Experience with amino-terminal pro-brain natriuretic peptide (NT-proBNP) testing for evaluation of dyspnoeic patients with suspected acute heart failure (HF) is limited to single-centre studies. We wished to establish broader standards for NT-proBNP testing in a study involving four sites in three continents.
METHODS AND RESULTS:
Differences in NT-proBNP levels among 1256 patients with and withoutacute HF and the relationship between NT-proBNP levels and HF symptoms were examined. Optimal cut-points for diagnosis and prognosis were identified and verified using bootstrapping and multi-variable logistic regression techniques. Seven hundred and twenty subjects (57.3%) had acute HF, whose median NT-proBNP was considerably higher than those without (4639 vs. 108 pg/mL, P<0.001), and levels of NT-proBNP correlated with HF symptom severity (P=0.008). An optimal strategy to identify acute HF was to use age-related cut-points of 450, 900, and 1800 pg/mL for ages <50, 50-75, and >75, which yielded 90% sensitivity and 84% specificity for acuteHF. An age-independent cut-point of 300 pg/mL had 98% negative predictive value to excludeacute HF. Among those with acute HF, a presenting NT-proBNP concentration >5180 pg/mL was strongly predictive of death by 76 days [odds ratio=5.2, 95% confidence interval (CI)=2.2-8.1, P<0.001].
CONCLUSION:
In this multi-centre, international study, NT-proBNP testing was valuable for diagnostic evaluation and short-term prognosis estimation in dyspnoeic subjects with suspected or confirmed acute HF and should establish broader standards for use of the NT-proBNP in dyspnoeic patients.
