N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study

ICON-RELOADED Investigators

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives: This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods: Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results: Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR− was 0.09 (95% CI: 0.05 to 0.13). Conclusions: In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF.

Original languageEnglish (US)
Pages (from-to)1191-1200
Number of pages10
JournalJournal of the American College of Cardiology
Volume71
Issue number11
DOIs
StatePublished - Mar 20 2018

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Natriuretic Peptides
Hospital Emergency Service
Heart Failure
Confidence Intervals
North America
ROC Curve
Dyspnea
Sensitivity and Specificity

Keywords

  • acute heart failure
  • biomarker
  • diagnosis
  • NT-proBNP
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department : The ICON-RELOADED Study. / ICON-RELOADED Investigators.

In: Journal of the American College of Cardiology, Vol. 71, No. 11, 20.03.2018, p. 1191-1200.

Research output: Contribution to journalArticle

@article{463ec172c56a4d448b8e65547b503043,
title = "N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study",
abstract = "Background: Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives: This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods: Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results: Of 1,461 subjects, 277 (19{\%}) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95{\%} confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7{\%}, 79.3{\%}, and 75.9{\%}, respectively; specificity was 93.9{\%}, 84.0{\%}, and 75.0{\%}, respectively. Positive predictive values were 53.6{\%}, 58.4{\%}, and 62.0{\%}, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95{\%} CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9{\%} and 98.0{\%}, respectively; LR− was 0.09 (95{\%} CI: 0.05 to 0.13). Conclusions: In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF.",
keywords = "acute heart failure, biomarker, diagnosis, NT-proBNP, prognosis",
author = "{ICON-RELOADED Investigators} and Januzzi, {James L.} and Chen-Tournoux, {Annabel A.} and Christenson, {Robert H.} and Gheorghe Doros and Hollander, {Judd E.} and Levy, {Phillip D.} and Nagurney, {John T.} and Nowak, {Richard M.} and Peter Pang and Darshita Patel and Peacock, {W. Franklin} and Rivers, {E. Joy} and Walters, {Elizabeth L.} and Gaggin, {Hanna K.}",
year = "2018",
month = "3",
day = "20",
doi = "10.1016/j.jacc.2018.01.021",
language = "English (US)",
volume = "71",
pages = "1191--1200",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "11",

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TY - JOUR

T1 - N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department

T2 - The ICON-RELOADED Study

AU - ICON-RELOADED Investigators

AU - Januzzi, James L.

AU - Chen-Tournoux, Annabel A.

AU - Christenson, Robert H.

AU - Doros, Gheorghe

AU - Hollander, Judd E.

AU - Levy, Phillip D.

AU - Nagurney, John T.

AU - Nowak, Richard M.

AU - Pang, Peter

AU - Patel, Darshita

AU - Peacock, W. Franklin

AU - Rivers, E. Joy

AU - Walters, Elizabeth L.

AU - Gaggin, Hanna K.

PY - 2018/3/20

Y1 - 2018/3/20

N2 - Background: Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives: This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods: Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results: Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR− was 0.09 (95% CI: 0.05 to 0.13). Conclusions: In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF.

AB - Background: Contemporary reconsideration of diagnostic N-terminal pro–B-type natriuretic peptide (NT-proBNP) cutoffs for diagnosis of heart failure (HF) is needed. Objectives: This study sought to evaluate the diagnostic performance of NT-proBNP for acute HF in patients with dyspnea in the emergency department (ED) setting. Methods: Dyspneic patients presenting to 19 EDs in North America were enrolled and had blood drawn for subsequent NT-proBNP measurement. Primary endpoints were positive predictive values of age-stratified cutoffs (450, 900, and 1,800 pg/ml) for diagnosis of acute HF and negative predictive value of the rule-out cutoff to exclude acute HF. Secondary endpoints included sensitivity, specificity, and positive (+) and negative (−) likelihood ratios (LRs) for acute HF. Results: Of 1,461 subjects, 277 (19%) were adjudicated as having acute HF. The area under the receiver-operating characteristic curve for diagnosis of acute HF was 0.91 (95% confidence interval [CI]: 0.90 to 0.93; p < 0.001). Sensitivity for age stratified cutoffs of 450, 900, and 1,800 pg/ml was 85.7%, 79.3%, and 75.9%, respectively; specificity was 93.9%, 84.0%, and 75.0%, respectively. Positive predictive values were 53.6%, 58.4%, and 62.0%, respectively. Overall LR+ across age-dependent cutoffs was 5.99 (95% CI: 5.05 to 6.93); individual LR+ for age-dependent cutoffs was 14.08, 4.95, and 3.03, respectively. The sensitivity and negative predictive value for the rule-out cutoff of 300 pg/ml were 93.9% and 98.0%, respectively; LR− was 0.09 (95% CI: 0.05 to 0.13). Conclusions: In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF.

KW - acute heart failure

KW - biomarker

KW - diagnosis

KW - NT-proBNP

KW - prognosis

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U2 - 10.1016/j.jacc.2018.01.021

DO - 10.1016/j.jacc.2018.01.021

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JO - Journal of the American College of Cardiology

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