Heart failure
The N-terminal Pro-BNP Investigation of Dyspnea in the Emergency department (PRIDE) study

https://doi.org/10.1016/j.amjcard.2004.12.032Get rights and content

The utility of aminoterminal pro-brain natriuretic peptide (NT-proBNP) testing in the emergency department to rule out acute congestive heart failure (CHF) and the optimal cutpoints for this use are not established. We conducted a prospective study of 600 patients who presented in the emergency department with dyspnea. The clinical diagnosis of acute CHF was determined by study physicians who were blinded to NT-proBNP results. The primary end point was a comparison of NT-proBNP results with the clinical assessment of the managing physician for identifying acute CHF. The median NT-proBNP level among 209 patients (35%) who had acute CHF was 4,054 versus 131 pg/ml among 390 patients (65%) who did not (p <0.001). NT-proBNP at cutpoints of >450 pg/ml for patients <50 years of age and >900 pg/ml for patients ≥50 years of age were highly sensitive and specific for the diagnosis of acute CHF (p <0.001). An NT-proBNP level <300 pg/ml was optimal for ruling out acute CHF, with a negative predictive value of 99%. Increased NT-proBNP was the strongest independent predictor of a final diagnosis of acute CHF (odds ratio 44, 95% confidence interval 21.0 to 91.0, p <0.0001). NT-proBNP testing alone was superior to clinical judgment alone for diagnosing acute CHF (p = 0.006); NT-proBNP plus clinical judgment was superior to NT-proBNP or clinical judgment alone. NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting.

Section snippets

Study population

The institutional review board approved all procedures involved in the PRIDE study. The PRIDE study is similar in design to the Breathing Not Properly Multinational study,3, 6 which assessed the use of BNP for patients who presented with dyspnea in the emergency department. The PRIDE study population was drawn from consenting patients ≥21 years of age who presented to the emergency department of the Massachusetts General Hospital (Boston, Massachusetts) with a complaint of dyspnea. Exclusion

Patients

Six hundred eligible patients were enrolled over 4 months. One patient withdrew consent at 60-day follow-up, leaving a final cohort of 599 patients. Of the 599 patients in the study, 209 (35%) had a final diagnosis of acute CHF, 35 (6%) had noncardiac dyspnea with a history of CHF, and the remaining 355 (59%) did not have CHF previously or the time of presentation.

Clinical characteristics

Comparisons of clinical characteristics at presentation between those patients who had acute CHF (n = 209) and those who did not (n

Discussion

Despite worldwide use of NT-proBNP testing, prospective data that examine its role in diagnosis of acute CHF in the emergency department has been limited to 2 reports with a relatively small number of patients.4, 5 In addition, although NT-proBNP is approved for ruling out CHF in the outpatient setting, the utility of the assay in the emergency department setting (for diagnosis and exclusion of acute CHF) remained unclear. Thus, the PRIDE study was prospectively performed to definitively

Acknowledgment

The investigators express their gratitude to John B. Newell, AB, for statistical analyses, the Massachusetts General Hospital Clinical Research Program for assistance in trial execution, and especially to the Massachusetts General Hospital emergency room for exceptional support and enthusiasm.

References (24)

  • A.S. Maisel et al.

    Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure

    N Engl J Med

    (2002)
  • A. Bayes-Genis et al.

    N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction

    Eur J Heart Fail

    (2004)
  • Cited by (1020)

    View all citing articles on Scopus

    This study was supported by a grant from Roche Diagnostics, Indianapolis, Indiana.

    View full text