Congestive heart failure: B-natriuretic peptide could help diagnose and exclude it

Clinical bottom line (level 2b)

  1. A third of patients presenting to urgent care with dyspnoea had congestive heart failure.
  2. An elevated B-natriuretic peptide made congestive heart failure more likely (LR + 22) , and a normal one ruled it out (LR - 0.022) .
Dao et al: J Am Coll Cardiol 2001; 37 : 379-385
Expires May 2004

The study

Setting: acute hospital, USA

250 patients (aged mean 63, 94% male) with dyspnoea

Excluded if
  • acute coronary syndrome unless predominant presentation was heart failure
  • dyspnoea clearly not due to heart failure (trauma or cardiac tamponade)


Independent blinded reference standard, applied in all patients from a non-consecutive appropriate spectrum.
Reference standard:
  • by 2 blinded cardiologists using subsequent investigations (chest X-ray, echocardiogram, pulmonary function tests, response to therapy) and Framingham criteria.
Diagnostic test: B-natriuretic peptide

The evidence

pre-test probability of congestive heart failure: 39%, (95% CI: 33% to 45%)

diagnostic test congestive heart failure no congestive heart failure LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
B-natriuretic peptide > 80 pg/ml 95 12 12
(7.2 to 22) 		89% 0.022
(0.0057 to 0.088) 		1%
total 97 153

Citation

  1. Dao Q, Krishnaswamy P, Kazanegra R, et al: utility of b-type natruiretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 2001; 37 : 379-385
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient dyspnoea
Intervention or Exposure B-natriuretic peptide
Outcome congestive heart failure