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J Am Geriatr Soc. 2005 Apr;53(4):643-8.

Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older.

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1
Department of Emergency Medicine and Surgery, Center Hospitalo-Universitaire, Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris, Université Pierre et Marie Curie, 47-83 boulevard de l'hôpital, 75013 Paris, France. patrick.ray@psl.ap-hop-paris.fr

Abstract

OBJECTIVES:

Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is difficult in elderly patients. The aim of this study was to compare the usefulness of B-type natriuretic peptide (BNP) and amino-terminal fragment BNP (proBNP), to diagnose CPE in patients aged 65 and older.

DESIGN:

Prospective study.

SETTING:

Medical emergency department of a 2,000-bed urban teaching hospital.

PARTICIPANTS:

Patients aged 65 and older presenting with acute dyspnea and a respiratory rate of 25 breaths/min or greater, a partial pressure of oxygen of 70 mmHg or less, or an oxygen saturation of 92% or less were included.

MEASUREMENTS:

Rapid BNP and proBNP assays, performed blind at admission, were compared with the final diagnosis (CPE or no CPE) as defined by an expert team.

RESULTS:

Two hundred two patients (mean age+/-standard deviation 80+/-9) were included; 88 (44%) had CPE. There was a strong correlation between proBNP and BNP values (correlation coefficient=0.91, P<.001). The median BNP and proBNP were higher in the group of patients with CPE (377 vs 74 pg/mL, P<.001, and 3,851 vs 495 pg/mL, P<.001, respectively). The best threshold values of BNP and proBNP were 250 pg/mL and 1,500 pg/mL, respectively. The area under the receiver operating characteristic curve was greater with BNP than with proBNP (0.85 vs 0.80, P<.05). BNP assay was more accurate in diagnosis than the emergency physician, whereas proBNP was not. Higher values of BNP and proBNP were associated with greater in-hospital mortality.

CONCLUSION:

BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older.

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