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QJM Advance Access originally published online on July 29, 2008
QJM 2008 101(11):831-843; doi:10.1093/qjmed/hcn080
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Differential diagnosis of acute dyspnea: the value of B natriuretic peptides in the emergency department

P. Ray1, S. Delerme1, P. Jourdain2 and C. Chenevier-Gobeaux3

From the 1Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), 47-83 boulevard de l’hôpital, 75013 Paris, UPMC Paris 6, France, 2Heart failure unit, Department of Cardiology, Hôpital de Pontoise, University Paris 5, France and 3Department of Biochemistry A, Hôpital Cochin, Assistance-Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, University Paris 5, France

Address correspondence to Dr P. Ray, Service d’Accueil des Urgences, Groupe Hospitalier Pitié-Salpêtrière, 47-83 boulevard de l’hôpital, 75013 Paris, France. email: patrick.ray{at}psl.ap-hop-paris.fr

Received 17 March 2008 and in revised form 20 June 2008


  Abstract

Congestive heart failure (CHF) is the main cause of acute dyspnea in patients presenting to an emergency department (ED) and is associated with high morbidity and mortality. B-type natriuretic peptide (BNP) is a polypeptide, released by ventricular myocytes in direct proportion to wall tension, which lowers renin–angiotensin–aldosterone activation. For the diagnosis of CHF, both BNP and the biologically inactive NT-proBNP have similar accuracy. Threshold values are higher in an elderly population, and in patients with renal dysfunction. They might also have a prognostic value. Studies have demonstrated that the use of BNP or NT-proBNP in dyspneic patients early following admission to the ED, reduced the time to discharge and total treatment cost. BNP and NT-proBNP should be available in every ED 24 h a day, because the literature strongly suggests the beneficial impact of an early appropriate diagnosis and treatment in dyspneic patients. The purpose of this review is to indicate recent developments in biomarkers of heart failure and to evaluate their impact on clinical use in the emergency setting.


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