B-Type Natriuretic Peptide in Heart Failure

• Published in: The New England journal of medicine Vol. 347; no. 24; pp. 1976 - 1978
• Main Authors: Colli, Agostino, Fraquelli, Mirella, Conte, Dario
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 12-12-2002
• Subjects: Atrial Natriuretic Factor - blood; Diagnosis, Differential; Dyspnea - etiology; Heart Failure - blood; Heart Failure - diagnosis; Humans; Likelihood Functions; Natriuretic Peptide, Brain; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - diagnosis
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM200212123472415

To the Editor:
Maisel et al. (July 18 issue)
1
suggest the usefulness of measurement of B-type natriuretic peptide in the diagnosis of left ventricular dysfunction in patients with acute dyspnea, but their conclusions must be challenged. With a cutoff level of 50 pg per milliliter for B-type natriuretic peptide, the negative likelihood ratio was 0.04, allowing them to rule out the diagnosis. Conversely, the specificity (83 percent) and the positive likelihood ratio (5.1) obtained with a cutoff level of 150 pg per milliliter seem too low to confirm the diagnosis definitely, because the post-test probability of symptomatic left ventricular dysfunction . . .