Tuberc Respir Dis.  2003 Mar;54(3):320-329. 10.4046/trd.2003.54.3.320.

The Application of B-Type Natriuretic Peptide Level of the Dyspneic Patients: Differentiation Between Cor Pulmonale and Left Ventricular Dysfunction

• Park HH
• Kim S
• Choi J
• Kim KH
• Cheon SC
• Lee J
• Lee YG
• Kim IJ
• Cha DH
• Hong SB
• Lee JH

• KMID: 1970581
• DOI: http://doi.org/10.4046/trd.2003.54.3.320

Abstract

BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control.
RESULTS
The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure.
CONCLUSION
Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.

Keyword

B-type natriuretic peptide; Right heart failure; Left heart failure

MeSH Terms

Ambulatory Care Facilities
Dyspnea
Emergency Service, Hospital
Heart Failure
Humans
Inpatients
Natriuretic Peptide, Brain*
Pulmonary Heart Disease*
ROC Curve
Ventricular Dysfunction, Left*
Natriuretic Peptide, Brain