Search

Background: Plasma B-type natriuretic peptide (BNP) assay is recommended as a diagnostic tool in emergency-room patients with acute dyspnea. In the intensive care unit (ICU), the utility of this peptide remains a matter of debate. The objectives of this study were to determine whether cut-off values for BNP and N-terminal-proBNP (NT-proBNP) reliably diagnosed right and/or left ventricular failure in patients with shock or acute respiratory distress, and whether non-cardiac factors led to an increase in these markers. Methods: Plasma BNP and NT-proBNP levels and echocardiographic parameters of cardiac dysfunction were determined in 41 patients within 24 h of the onset of shock or acute respiratory distress. Results: BNP and NT-proBNP levels were higher in the 25 patients with heart failure than in the other 16 patients: 491.7 ± 418 pg/ml vs. 144.3 ± 128 pg/ml and 2874.4 ± 2929 pg/ml vs. 762.7 ± 1128 pg/ml, respectively ( P < 0.05). In the diagnosis of cardiac dysfunction, BNP > 221 pg/ml and NT-proBNP > 443 pg/ml had 68% and 84% sensitivity, respectively, and 88% and 75% specificity, respectively, but there was a substantial overlap of BNP and NT-proBNP values between patients with and without heart failure. BNP and NT-proBNP were elevated, but not significantly, in patients with isolated right ventricular dysfunction. Patients with renal dysfunction and normal heart function had significantly higher levels of BNP (258.6 ± 144 pg/ml vs. 92.4 ± 84 pg/ml) and NT-proBNP (2049 ± 1320 pg/ml vs. 118 ± 104 pg/ml) than patients without renal dysfunction. Conclusion: Both BNP and NT-proBNP can help in the diagnosis of cardiac dysfunction in ICU patients, but cannot replace echocardiography. An elevated BNP or NT-proBNP level merely indicates the presence of a ‘cardiorenal distress’ and should prompt further investigation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS. Study design: Prospective clinical trial. Patients and methods: At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA>0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement. Results: 26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189–4830] vs 145.5 [36.5–346] pg/ml (P =0.01) but in those with creatinine clearance<90 ml/min: 602 [331–3530] vs 125 [39–189] pg/ml (P =0.007). BNP was correlated with RVA (r=0.5; p =0.01), RVA/LVA ratio (r=0.61; p =0.001), sPAP (r=0.58; p =0.002) and with age, cardiac index and creatinine clearance (r=0.61; p =0.001). In multivariate analysis, BNP was only correlated with creatinine clearance (p =0.03), and RVA (p =0.06). Conclusion: In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale. [Copyright &y& Elsevier]