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Original ArticleOpen Access
Role of the Plasma Brain Natriuretic Peptide in Differentiating Patients with Congestive Heart Failure from Other Diseases
Sirithunyanont C 
,
Leowattana W ,
Sukumalchantra Y ,
Chaisupamonkollarp S ,
Watanawaroon S ,
Chivatanaporn MB ,
Bhuripanyo K ,
Mahanonda N
,
Leowattana W ,
Sukumalchantra Y ,
Chaisupamonkollarp S ,
Watanawaroon S ,
Chivatanaporn MB ,
Bhuripanyo K ,
Mahanonda N Background
: Heart failure (HF) is primarily a disease of the elderly. The incidence of
congestive heart failure (CHF) in Thailand has been increasing during the last 10 years. Unlike other
diseases, physicians have only rough patients' symptoms and physical findings to guide the adequacy
of treatment. Recently, there has been evidence of the role of brain natriuretic peptide (BNP) and its
use in HF concerning diagnosis, prognosis, and treatment follow-up. The purpose of this study was
to determine the sensitivity and specificity of N-terminal part of brain natriuretic peptide plasma level
(NT -proBNP) in the diagnosis of
HF
in Thai patients who presented with dyspnea.
Method:
The design was a cross sectional study. The authors enrolled 50 consecutive patients
from the Respiratory Unit with dyspnea from chronic obstructive pulmonary disease (COPD). asthma,
or anxiety. The cardiovascular cause of dyspnea such as pulmonary emboli and poor left ventricular
ejection fraction (L VEF) were excluded. Forty eight consecutive patients with evidence of HF who pre-
sented to the Cardiac; Center with a history of dyspnea on exertion were assigned as cases. Five milli-
liters of venous blood samples were taken and sent together with 200 samples from a normal healthy
population from the check up department for NT-proBNP measurement.
Results
: In case and control groups, there were no statistical significances in sex (males
68.8%
vs
females 52.0%, p > 0.05) and age (63.3
เธ‘
14.9
vs
55.6
เธ‘
16.9; p > 0.05). The mean left ventri-
cular ejection fraction in the case group was 32.4
เธ‘
9.7 per cent. There was significant difference be-
tween value of NT -proBNP in the control group (386
เธ‘
1,041 pg/ml) and in the case group (8,912
เธ‘
12,525 pg/ml, p
<
0.001). To diagnose HF in patients who presented with dyspnea using the cut-off
value of NT-proBNP at> 150 pg/ml in patients with dyspnea the sensitivity was 96 per cent, and the
specificity of 72 per cent; at> 200 pg/m1 the sensitivity was 96 per cent and the specificity was 80 per
cent and at > 300 pg/ml the sensitivity was 94 per cent and specificity of 82 per cent. Plasma level of
NT-proBNP increased significantly with increasing New York Heart Association (NYHA) functional
class (class II: 1,107
เธ‘
1,091 pg/ml; class III: 5,097
เธ‘
4,201 pg/ml, class IV: 19,389
เธ‘
15,966 pg/ml
p
<
0.01). There was no significant difference of plasma NT-proBNP levels in patients with ischemic
(8,586
เธ‘
11,601 pg/ml; n
=
35) and those with non ischemic cardiomyopathy (9,789
เธ‘
15,229 pg/ml;
n
=
13). Plasma NT-proBNP was associated with neck vein distension (p
<
0.05) but there was no
S88
C.
: Heart failure (HF) is primarily a disease of the elderly. The incidence of
congestive heart failure (CHF) in Thailand has been increasing during the last 10 years. Unlike other
diseases, physicians have only rough patients' symptoms and physical findings to guide the adequacy
of treatment. Recently, there has been evidence of the role of brain natriuretic peptide (BNP) and its
use in HF concerning diagnosis, prognosis, and treatment follow-up. The purpose of this study was
to determine the sensitivity and specificity of N-terminal part of brain natriuretic peptide plasma level
(NT -proBNP) in the diagnosis of
HF
in Thai patients who presented with dyspnea.
Method:
The design was a cross sectional study. The authors enrolled 50 consecutive patients
from the Respiratory Unit with dyspnea from chronic obstructive pulmonary disease (COPD). asthma,
or anxiety. The cardiovascular cause of dyspnea such as pulmonary emboli and poor left ventricular
ejection fraction (L VEF) were excluded. Forty eight consecutive patients with evidence of HF who pre-
sented to the Cardiac; Center with a history of dyspnea on exertion were assigned as cases. Five milli-
liters of venous blood samples were taken and sent together with 200 samples from a normal healthy
population from the check up department for NT-proBNP measurement.
Results
: In case and control groups, there were no statistical significances in sex (males
68.8%
vs
females 52.0%, p > 0.05) and age (63.3
เธ‘
14.9
vs
55.6
เธ‘
16.9; p > 0.05). The mean left ventri-
cular ejection fraction in the case group was 32.4
เธ‘
9.7 per cent. There was significant difference be-
tween value of NT -proBNP in the control group (386
เธ‘
1,041 pg/ml) and in the case group (8,912
เธ‘
12,525 pg/ml, p
<
0.001). To diagnose HF in patients who presented with dyspnea using the cut-off
value of NT-proBNP at> 150 pg/ml in patients with dyspnea the sensitivity was 96 per cent, and the
specificity of 72 per cent; at> 200 pg/m1 the sensitivity was 96 per cent and the specificity was 80 per
cent and at > 300 pg/ml the sensitivity was 94 per cent and specificity of 82 per cent. Plasma level of
NT-proBNP increased significantly with increasing New York Heart Association (NYHA) functional
class (class II: 1,107
เธ‘
1,091 pg/ml; class III: 5,097
เธ‘
4,201 pg/ml, class IV: 19,389
เธ‘
15,966 pg/ml
p
<
0.01). There was no significant difference of plasma NT-proBNP levels in patients with ischemic
(8,586
เธ‘
11,601 pg/ml; n
=
35) and those with non ischemic cardiomyopathy (9,789
เธ‘
15,229 pg/ml;
n
=
13). Plasma NT-proBNP was associated with neck vein distension (p
<
0.05) but there was no
S88
C.
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