Study supports biomarker assay for emergency department diagnosis of acute heart failure

March 22, 2018, Massachusetts General Hospital

A multi-institutional study supports the value of a biomarker to accurately diagnose or rule out acute heart failure in patients seen for shortness of breath at hospital emergency departments. The report published in the Journal of the American College of Cardiology also validates the use of age-adjusted thresholds of the protein NT-proBNP to diagnose heart failure in a wide range of such patients.

"Since we did the first U.S.-based studies of NT-proBNP for the identification or exclusion of , as well as for establishing the risk of bad outcomes, its use has been incorporated into diagnostic guidelines internationally," says James Januzzi Jr., MD, of the Massachusetts General Hospital Division of Cardiology, who led the study. "But over the past 15 years, the characteristics of patients with failure have changed - they tend to be older, are more likely to be women and to have additional complications - making a contemporary re-assessment of the assay's performance necessary.

NT-proBNP (N-terminal pro-brain natriuretic peptide) and a related protein called BNP (B-type natriuretic peptide) are both produced when the cardiac muscle is under stress. One of the earliest studies of the value of NT-proBNP testing, conducted in the MGH Emergency Department, suggested age-based diagnostic cutoffs for diagnosis of - 450 pg/ml for patients under 50, 900 pg/ml for those 50 to 75, and 1,800 pg/ml for those over 75. An NT-proBNP level of 300 or below appeared to rule out acute heart failure no matter the patient's age.

Use of those cutoffs was supported by a larger, multi-institutional trial, but while they have been largely adopted at hospitals worldwide, the only NT-proBNP diagnostic cutoffs approved by the U.S. Food and Drug Administration (FDA) are 125 pg/ml for patients under 75 and 450 pg/ml for those 75 and older - levels designed for use in conjunction with outpatient treatment. The current study, conducted by the Baim Institute for Clinical Research, and led by Januzzi, was designed both to validate the emergency-care-based cutoffs and to determine whether they remain useful for assessment of the current population of patients with heart failure.

Conducted in 2015 and 2016 at 19 sites in the U.S. and Canada, the study enrolled 1,461 adult patients who had come to hospital emergency departments with shortness of breath or other breathing difficulties. Blood samples to be measured for NT-proBNP levels were taken upon study enrollment, and determination of the presence of acute heart failure - separate from the clinical diagnosis that guided participants' care - was made by clinicians blinded to individual participants' NT-proBNP levels. Overall, 277 patients - 19 percent of total study enrollment - were determined to have acute heart failure.

Comparison of participants' NT-proBNP levels with their eventual diagnoses supported the usefulness of the age-based cutoff levels and that a level below 300 strongly excluded a heart failure diagnosis. These results were consistent across all groups of participants, no matter their age, gender, racial or ethnic background or the presence of conditions like obesity or kidney disease.

"We found no specific population in which the test did not perform well, and what was most striking to me - as someone who has been working with NT-proBNP since the early 2000s - was how consistent these results were with those of prior studies," says Januzzi, who is the Hutter Family Professor of Medicine in the Field of Cardiology at Harvard Medical School. "Given the changes in the types of with heart failure we see today, it's quite remarkable how reliable this test is."

Januzzi and his colleague expect their results will extend the use of age-based NT-proBNP cutoffs even further, which by allowing faster and more accurate diagnosis or exclusion of heart should lead to better patient outcomes. They also anticipate FDA approval of the age-based cutoffs for emergency department diagnosis.

Explore further: NT-proBNP improves heart failure prediction in T2DM

More information: Journal of the American College of Cardiology (2018). DOI: 10.1016/j.jacc.2018.01.02

Related Stories

NT-proBNP improves heart failure prediction in T2DM

July 18, 2017
(HealthDay)—For patients with type 2 diabetes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) improves prediction of heart failure, according to a study published online July 6 in Diabetes Care.

NT-ProBNP-guided treatment no benefit in high-risk HFrEF

August 23, 2017
(HealthDay)—For high-risk patients with heart failure and reduced ejection fraction (HFrEF), an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy does not improve clinical outcomes versus ...

Biomarker-guided heart failure treatment significantly reduces complications

October 17, 2011
Adding regular testing for blood levels of a biomarker of cardiac distress to standard care for the most common form of heart failure may significantly reduce the incidence of cardiovascular complications, a new study finds. ...

Simple tool can predict serious adverse events in acute heart failure patients

March 6, 2017
More than one million patients are admitted to the hospital with heart failure each year. A prospective clinical validation found the Ottawa Heart Failure Risk Scale (OHFRS) tool to be highly sensitive for serious adverse ...

Blood tests predict kidney disease patients' risk of developing heart failure

October 2, 2014
Two blood markers are strongly linked with the development of heart failure in individuals with mild to severe kidney disease, according to a study appearing in an upcoming issue of the Journal of the American Society of ...

Exercise protects against heart failure even at advanced ages

November 15, 2012
(HealthDay)—Among older adults, physical activity may protect against heart failure, as indicated by lower levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT), according to a study ...

Recommended for you

A better clot-buster drug for strokes?

April 26, 2018
(HealthDay)—After a stroke, many patients are given the clot-busting intravenous drug alteplase, but another drug may be more effective, Australian researchers report.

Imaging may allow safe tPA treatment of patients with unwitnessed strokes

April 25, 2018
A study led by Massachusetts General Hospital (MGH) investigators may lead to a significant expansion in the number of stroke patients who can safely be treated with intravenous tPA (tissue plasminogen activator), the "clot ...

Mice make over four times as many new heart muscle cells when they exercise, study finds

April 25, 2018
Doctors, health organizations, and the Surgeon General all agree that exercise is good for the heart—but the reasons why are still not well understood.

Heart disease may only be a matter of time for those with healthy obesity

April 24, 2018
People who are 30 pounds or more overweight may want to slim down a bit even if they don't have high blood pressure or any other heart disease risk, according to scientists at Wake Forest Baptist Medical Center.

Women at greater risk of stress-induced ischemia after heart attacks

April 24, 2018
Women who've previously experienced a heart attack have twice the risk of later myocardial ischemia provoked by mental stress when compared to men with a similar history, according to a study published in Circulation.

A wearable device intervention to increase exercise in peripheral artery disease

April 24, 2018
A home-based exercise program, consisting of wearable devices and telephone coaching, did not improve walking ability for patients with peripheral artery disease, according to a new Northwestern Medicine study.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.