Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Blood test can accurately diagnose heart failure in emergency patients

11.04.2005


Measuring protein level provides accurate assessment for patients with shortness of breath

A new blood test that measures a particular marker of cardiac distress can markedly improve the ability to diagnose or exclude congestive heart failure in patients with shortness of breath who come to hospital emergency departments. The report from researchers at Massachusetts General Hospital (MGH) finds that measuring levels of a protein called NT-proBNP was significantly better at identifying heart failure than was standard clinical evaluation. The report will appear in the April 15 issue of the American Journal of Cardiology and has been released online prior to print publication.

"We found that testing with the NT-proBNP assay was an extremely accurate way to identify or exclude heart failure in patients with shortness of breath," says James Januzzi Jr., MD, of the MGH Cardiology Division, the paper’s lead author. "Importantly, we also found that the very best results came from combining the results of this very sensitive and specific blood test with the logic and wisdom of a good emergency physician, which gave the optimal balance between biologic data and clinical judgement."



Congestive heart failure, which occurs when an impaired heart muscle cannot pump blood efficiently, is a growing health problem and major cause of cardiac death. The diagnosis of heart failure may be difficult to make because its typical symptoms can overlap with those of other conditions. Missing a heart failure diagnosis can put patients at high risk of serious problems, including death, but overdiagnosis may lead patients to receive unnecessary treatment.

"To date, the way physicians have traditionally evaluated potential heart failure patients has been rather random, with some receiving a physical examination and medical history while others also get expensive and time-consuming procedures," Januzzi says. "Having a widely-available, accurate, and cost-effective diagnostic method would be of extraordinary value."

Proteins called natriuretic peptides are produced when the cardiac muscle is under stress. The role of testing for these proteins in several forms of cardiovascular disease has been the subject of intense recent study. In 2002, the newest generation of natriuretic peptide assays became available, and soon thereafter the current investigation – called the PRIDE study – was launched to determine the usefulness of a test for NT-proBNP in evaluating emergency patients. At the time of its launch, the PRIDE study was the first prospective American trial of NT-proBNP and the largest such study to study the test in patients with shortness of breath.

About 600 patients who came to the MGH Emergency Department with shortness of breath were enrolled in the study. In addition to standard evaluation of symptoms, a blood sample was drawn for NT-proBNP measurement. After the emergency assessment was completed, the attending physicians were asked to estimate the likelihood that the patients’ symptoms were caused by heart failure, based on all available information except the NT-proBNP assay. For patients admitted to the hospital, the entire record of their stay was included in the study data. Sixty days after the original emergency visit, the researchers followed up with each patient, contacting them personally and reviewing their records to identify any subsequent clinical events. Participation in the study in no way changed the care or treatment the patients received.

To determine the diagnoses for this study, cardiologists not involved in the patients’ care reviewed all the participants’ relevant hospital records from the initial emergency visit through the 60-day follow up. In assigning the final diagnosis – either acute heart failure or some other cause for shortness of breath – these physicians also did not have access to the NT-proBNP results.

When they reviewed NT-proBNP levels, the researchers found that the protein’s concentrations were significantly higher in patients eventually diagnosed with heart failure and highest in those with most severe symptoms. For identifying heart failure in these emergency patients, the test alone was significantly more accurate than was the physicians’ original likelihood assessment, but a combination of NT-proBNP levels and physician judgement produced the most accurate method of diagnosis.

"We also identified specific NT-proBNP levels above which the diagnosis of heart failure is clear and below which the symptoms are definitely not cardiac-related," Januzzi says. "So we’ve shown that this test not only can confidently exclude the presence of congestive heart failure, which other studies have examined, but can confirm that diagnosis as well. NT-proBNP performed exceptionally well and confirms the value of the natriuretic peptide class of cardiac biomarkers as a whole. We believe NT-proBNP testing should now become a routine component of evaluation for patients with shortness of breath in emergency department settings." Januzzi is an assistant professor of Medicine at Harvard Medical School.

Co-authors of the study – all from the MGH – are Carlos Camargo, MD, PhD; Saif Anwaruddin, MD; Aaron Baggish, MD; Annabel Chen, MD; Daniel Krauser, MD; Roderick Tung, MD; Renee Cameron, MS; Tobias Nagurney, MD; Claudia Chae, MD, MPH; Donald Lloyd-Jones, MD, ScM; David Brown, MD; Stacy Foran-Melanson, MD, PhD; Patrick Sluss, MD, PhD; Elizabeth Lee-Lewandrowski, PhD, MPH; and Kent Lewandrowski, MD. The study was supported by a grant from Roche Diagnostics, which manufacturers the NT-proBNP assay studied.

Sue McGreevey | EurekAlert!
Further information:
http://www.mgh.harvard.edu

More articles from Health and Medicine:

nachricht Using fragment-based approaches to discover new antibiotics
21.06.2018 | SLAS (Society for Laboratory Automation and Screening)

nachricht Scientists learn more about how gene linked to autism affects brain
19.06.2018 | Cincinnati Children's Hospital Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Temperature-controlled fiber-optic light source with liquid core

In a recent publication in the renowned journal Optica, scientists of Leibniz-Institute of Photonic Technology (Leibniz IPHT) in Jena showed that they can accurately control the optical properties of liquid-core fiber lasers and therefore their spectral band width by temperature and pressure tuning.

Already last year, the researchers provided experimental proof of a new dynamic of hybrid solitons– temporally and spectrally stationary light waves resulting...

Im Focus: Overdosing on Calcium

Nano crystals impact stem cell fate during bone formation

Scientists from the University of Freiburg and the University of Basel identified a master regulator for bone regeneration. Prasad Shastri, Professor of...

Im Focus: AchemAsia 2019 will take place in Shanghai

Moving into its fourth decade, AchemAsia is setting out for new horizons: The International Expo and Innovation Forum for Sustainable Chemical Production will take place from 21-23 May 2019 in Shanghai, China. With an updated event profile, the eleventh edition focusses on topics that are especially relevant for the Chinese process industry, putting a strong emphasis on sustainability and innovation.

Founded in 1989 as a spin-off of ACHEMA to cater to the needs of China’s then developing industry, AchemAsia has since grown into a platform where the latest...

Im Focus: First real-time test of Li-Fi utilization for the industrial Internet of Things

The BMBF-funded OWICELLS project was successfully completed with a final presentation at the BMW plant in Munich. The presentation demonstrated a Li-Fi communication with a mobile robot, while the robot carried out usual production processes (welding, moving and testing parts) in a 5x5m² production cell. The robust, optical wireless transmission is based on spatial diversity; in other words, data is sent and received simultaneously by several LEDs and several photodiodes. The system can transmit data at more than 100 Mbit/s and five milliseconds latency.

Modern production technologies in the automobile industry must become more flexible in order to fulfil individual customer requirements.

Im Focus: Sharp images with flexible fibers

An international team of scientists has discovered a new way to transfer image information through multimodal fibers with almost no distortion - even if the fiber is bent. The results of the study, to which scientist from the Leibniz-Institute of Photonic Technology Jena (Leibniz IPHT) contributed, were published on 6thJune in the highly-cited journal Physical Review Letters.

Endoscopes allow doctors to see into a patient’s body like through a keyhole. Typically, the images are transmitted via a bundle of several hundreds of optical...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Munich conference on asteroid detection, tracking and defense

13.06.2018 | Event News

2nd International Baltic Earth Conference in Denmark: “The Baltic Sea region in Transition”

08.06.2018 | Event News

ISEKI_Food 2018: Conference with Holistic View of Food Production

05.06.2018 | Event News

 
Latest News

Graphene assembled film shows higher thermal conductivity than graphite film

22.06.2018 | Materials Sciences

Fast rising bedrock below West Antarctica reveals an extremely fluid Earth mantle

22.06.2018 | Earth Sciences

Zebrafish's near 360 degree UV-vision knocks stripes off Google Street View

22.06.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>