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Objective: To compare head to head the diagnostic accuracy of B type natriuretic peptide (BNP) and the amino terminal fragment of its precursor hormone (NT-proBNP) for congestive heart failure (CHF) in an emergency selling. Methods: 251 consecutive patients presenting to the emergency department with dyspnoea as a chief complaint were prospectively studied. Patients with acute coronary syndromes were excluded. The diagnosis of CHF was based on the Framingham score for CHF plus echocardiographic evidence of systolic or diastolic dysfunction. Blood concentrations of BNP and NT-proBNP were measured by two commercially available assays (Abbolt and Roche methods). The diagnostic accuracies of BNP and NT- proBNP were assessed by receiver operating characteristic curve analysis. Results: Areas under the curve for BNP and NT-proBNP in patients with dyspnoea caused by CHF (n = 137) and in patients with dyspnoea attributable to other reasons (n = 114) did not differ significantly (area under the curve 0.916 v 0.903, p = 0.277, statistical power 94%). Cut off concentrations with the highest diagnostic accuracy were 295 ng/l for BNP (sensitivity 80%, specificity 86%, diagnostic accuracy 83%) and 825 ng/l for NT-proBNP (sensitivity 87%, specificity 81 %, diagnostic accuracy 84%). Evaluation of discordant false classifications at these cut off concentrations showed no advantage for either BNP nor NT-proBNP in the biochemical diagnosis of CHF (17 misclassifications by BNP and 14 by NT-proBNP, p = 0.720). In the population studied, age, sex, and renal function had no impact on the diagnostic utility of both tests when compared by logistic regression models. Conclusions: BNP and NT-proBNP may be equally useful as an aid in the diagnosis of CHF in short of breath patients presenting to the emergency department. [ABSTRACT FROM AUTHOR]

There are currently no data on whether high total serum homocysteine (tHcy) is predictive for cerebrovascular events in patients with symptomatic peripheral arterial disease (PAD). Therefore, the purpose of this study was to determine whether high tHcy levels were related to the evidence of non-fatal stroke in PAD. Evidence of non-fatal atherothrombotic stroke events was verified in 450 consecutive male patients, admitted for inpatient treatment of symptomatic PAD. The extent of carotid stenosis was evaluated by colour duplex Doppler measurement and fasting tHcy was determined by high-performance liquid chromatography. Within the population of 450 PAD patients a documented history of ischaemic stroke was evident in 50 subjects. The median tHcy values were significantly higher in PAD patients with stroke (18.6 μmol/l) than in PAD patients without stroke (15.1 μmol/l, P < 0.001). Logistic regression analysis revealed that tHcy was an independent and significant predictor ( P =0.001) with an odds ratio (OR) of 1.37 for an increment of 5 μmol/l. In this multivariate model, diabetes mellitus (OR=2.34, P =0.011) and carotid stenosis ≥50% (OR=2.59, P =0.005) were also independently related to clinical cerebrovascular disease in PAD. In conclusion, the present study demonstrates an association of tHcy and evidence of non-fatal atherothrombotic stroke in patients with symptomatic PAD. This could be important, as a reduction of elevated tHcy concentrations by vitamin supplement might decrease the high frequency of cerebrovascular complications in PAD patients. [ABSTRACT FROM AUTHOR]

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High total serum homocysteine (tHcy) concentrations are associated with an increased risk of carotid artery disease in the general population. Since patients with peripheral arterial disease (PAD) have a threefold risk of cerebrovascular morbidity compared to individuals free of PAD, and since the total neurological event rate is associated with a &ges;50% lumen reduction in extracranial carotid arteries, it was tested whether tHcy is a predictor of internal carotid artery stenosis in patients with symptomatic PAD. A total of 443 consecutive male PAD patients without previous carotid surgery/stenting were studied. In all, 100 patients with PAD had an internal carotid artery stenosis &ges;50%. Of the remaining 343 patients, 100 individuals matched for age (±2 years) and diabetes served as controls. The extent of carotid stenosis was evaluated with color duplex measurement; tHcy was determined by high-performance liquid chromatography. Cases displayed a significantly higher median fasting tHcy level (17.0 μmol/l) than controls (13.7 μmol/l, p = 0.001). Multivariate analysis showed that tHcy (p = 0.036) was an independent predictor of internal carotid artery stenosis ≥50% in PAD patients, representing an odds ratio of 1.32 (95% CI, 1.02–1.72) for an increment of 5 μmol/l. In the present study, high tHcy was an independent risk factor for an internal carotid artery stenosis ≥50% in patients with PAD. Since PAD patients suffer a threefold risk of stroke compared to healthy individuals, a simple vitamin substitution in PAD patients may reduce the occurrence of internal carotid artery stenosis and therefore diminish the relatively high rate of cerebrovascular events in this population. [ABSTRACT FROM AUTHOR]

An abstract of the article "Chromogranin A and C-terminal endothelin-1 precursor fragment add independent prognostic information to amino-terminal proBNP in patients with acute destabilized heart failure," by B. Dieplinger and colleagues is presented.

The article discusses how do B type natriuretic peptide (BNP) concentrations compare with amino terminal proBNP concentrations for detecting congestive heart failure (CHF) in emergency department (ED). The study was conducted in 251 ED patients who had shortness of breath as the most prominent symptom. Patients with acute coronary syndromes were excluded. 55% of patients had dyspnoea caused by CHF. In emergency department patients with dyspnoea, BNP and amino terminal proBNP concentrations had similar diagnostic accuracy for detecting congestive heart failure.