Impact of the History of Congestive Heart Failure on the Utility of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure: Results from.

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Date of download: 6/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: Utility of B-type natriuretic peptide in the diagnosis.

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Presentation transcript:

Impact of the History of Congestive Heart Failure on the Utility of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure: Results from the Breathing Not Properly Multinational Study Adam Strunk, MD, Vikas Bhalla, MD, Paul Clopton, MS, Richard M. Nowak, MD, MBA, James McCord, MD, Judd E. Hollander, MD, Philippe Duc, MD, Alan B. Storrow, MD, William T. Abraham, MD, Alan H.B. Wu, PhD, Gabriel Steg, MD, Alberto Perez, MD, Radmila Kazanegra, MD, Howard C. Herrmann, MD, Marie Claude Aumont, MD, Peter A. McCullough, MD, MPH, Alan Maisel, MD The American Journal of Medicine Volume 119, Issue 1, Pages 69.e1-69.e11 (January 2006) DOI: 10.1016/j.amjmed.2005.04.029 Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 1 Receiver operating characteristic curves for B-type natriuretic peptide predicting diagnosis of acute congestive heart failure in patient subgroups with presence or absence of a history of congestive heart failure. AUC = area under the curve; CI = confidence interval. The American Journal of Medicine 2006 119, 69.e1-69.e11DOI: (10.1016/j.amjmed.2005.04.029) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 2 Misclassification cost curves. Graph A is constructed assuming the relative cost of false negative to false positive diagnoses to be 1:1; graph B assumes relative costs of 2:1. BNP = B-type natriuretic peptide. The American Journal of Medicine 2006 119, 69.e1-69.e11DOI: (10.1016/j.amjmed.2005.04.029) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 3 Cumulative statistics for BNP group, history of CHF, and index criteria (cut-point of 2). BNP = B-type natriuretic peptide; CHF = congestive heart failure; LR = likelihood ratio; PPV = positive predictive value; NPV = negative predictive value. The American Journal of Medicine 2006 119, 69.e1-69.e11DOI: (10.1016/j.amjmed.2005.04.029) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 4 Structured nomogram for use in assessing the probability of CHF for a given patient. It integrates the patient’s BNP level, history of CHF, and the presence of at least 2 of the index criteria (criteria positive or negative). To use this nomogram, one must draw a straight line from the appropriate BNP range on the left axis through the appropriate criteria point on the central axis through the axis on the right. The posttest probability intercepts with the far right axis. CHF = congestive heart failure; BNP = B-type natriuretic peptide. The American Journal of Medicine 2006 119, 69.e1-69.e11DOI: (10.1016/j.amjmed.2005.04.029) Copyright © 2006 Elsevier Inc. Terms and Conditions