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dc.contributor.authorJanuzzi, Jr., J.L.
dc.contributor.authorChen-Tournoux, A.A.
dc.contributor.authorChristenson, R.H.
dc.date.accessioned2019-06-21T18:46:25Z
dc.date.available2019-06-21T18:46:25Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85042743372&doi=10.1016%2fj.jacc.2018.01.021&partnerID=40&md5=0dbc1978e9083909c8411a5dce049f5d
dc.identifier.urihttp://hdl.handle.net/10713/9675
dc.description.abstractBackground: 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. Copyright 2018 American College of Cardiology Foundationen_US
dc.description.urihttps://dx.doi.org/10.1016/j.jacc.2018.01.021en_US
dc.language.isoen-USen_US
dc.publisherElsevier USAen_US
dc.relation.ispartofJournal of the American College of Cardiology
dc.subjectacute heart failureen_US
dc.subjectbiomarkeren_US
dc.subjectdiagnosisen_US
dc.subjectNT-proBNPen_US
dc.subjectprognosisen_US
dc.titleN-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/j.jacc.2018.01.021


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