Permanent/paroxysmal atrial fibrillation reduced the diagnostic accuracy of BNP for acute heart failure (AUC 0.84 vs 0.91 without AF), suggesting a higher diagnostic threshold is needed.
Cohort (n=1,431)
Does the presence of atrial fibrillation affect the diagnostic performance of B-type natriuretic peptide for acute congestive heart failure in patients presenting with acute dyspnea?
Atrial fibrillation elevates BNP levels in patients without heart failure, reducing the specificity of standard BNP cutoffs and necessitating higher diagnostic thresholds for acute heart failure in this population.
Absolute Event Rate: 0.84% vs 0.91%
OBJECTIVES: This study was designed to assess the diagnostic performance of B-type natriuretic peptide (BNP) in the diagnosis of acute congestive heart failure (CHF) in patients with permanent/paroxysmal atrial fibrillation (AF) presenting with acute dyspnea. BACKGROUND: It is unknown to what extent AF affects the diagnostic performance of BNP in patients presenting with acute dyspnea. METHODS: We studied 1,431 patients drawn from a cohort of patients (n = 1,586) with acute dyspnea who had BNP levels measured on arrival. Patients were prospectively classified according to the presence or absence of permanent/paroxysmal AF. RESULTS: In total, 292 patients had permanent/paroxysmal AF. In patients without HF, permanent/paroxysmal AF was associated with significantly higher BNP levels (p = 0.001). Conversely, in patients with HF, BNP levels did not differ significantly between patients with and without AF (p = 0.533). A BNP cutoff value of 100 pg/ml had a specificity of 40% and 79% for the diagnosis of acute HF in patients with and without AF, respectively. The areas under the receiver-operating characteristic curves were 0.84 (95% confidence interval 0.78 to 0.89) and 0.91 (95% confidence interval 0.89 to 0.93) for patients with and without AF, respectively. CONCLUSIONS: In patients without, but not in those with HF, the presence of AF is associated with higher circulating BNP levels, suggesting that a higher diagnostic threshold should be used in patients with AF.
Knudsen et al. (Wed,) conducted a cohort in Acute dyspnea (n=1,431). Permanent/paroxysmal atrial fibrillation vs. Absence of atrial fibrillation was evaluated on Diagnostic performance (AUC) of BNP for acute heart failure. Permanent/paroxysmal atrial fibrillation reduced the diagnostic accuracy of BNP for acute heart failure (AUC 0.84 vs 0.91 without AF), suggesting a higher diagnostic threshold is needed.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: