B-type natriuretic peptide predicts sudden death in patients with chronic heart failure.

Abstract

HomeCirculationVol. 107, No. 1B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBB-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure Morrison Hodges James J. Bailey Timothy R. Church Morrison HodgesMorrison Hodges Minneapolis Heart Institute Foundation, Minneapolis, Minn Search for more papers by this author James J. BaileyJames J. Bailey National Institutes of Health, Bethesda, Md Search for more papers by this author Timothy R. ChurchTimothy R. Church University of Minnesota, Minneapolis, Minn Search for more papers by this author Originally published7 Jan 2003https://doi.org/10.1161/01.CIR.0000046777.74753.F8Circulation. 2003;107:e13To the Editor:Berger et al1 conclude that “BNP levels are a strong, independent predictor of sudden death in patients with CHF.” The predictive utility of a diagnostic test is usually expressed as predictive values, either positive predictive value (PPV, ratio of number of patients with true-positive test results to all patients with positive test results) or negative predictive value (NPV, ratio of number with true-negative test results to all patients with negative test results).2 Using the data Berger et al1 give on page 2394 for a BNP (B-type natriuretic peptide) cutpoint of 130 pg/mL, the PPV is 19% and the NPV is 99%. Thus, although a BNP level below 130 would allow the clinician to reassure a patient that sudden cardiac death (SCD) is very unlikely, putting implantable cardioverter-defibrillators (ICDs) in all patients with a BNP value above 130 pg/mL implies implanting 5 ICDs for every one that would discharge appropriately in the first 3 years. Many would regard this as financially infeasible. In addition, the prior probability of SCD in their study population is 13% (44/337), a number that is improved only to 19% by using BNP levels with a cutpoint of 130 pg/mL.The authors apparently chose a cutpoint that would maximize sensitivity (99% at the chosen cutpoint), but this results in a rather low specificity (37%). It would be nice to see a receiver-operating characteristic (ROC) curve for their data, ie, a plot of the true-positive rate (sensitivity) against the false-positive rate (1−specificity). This would allow for better adjudication of the inevitable tradeoff between sensitivity and specificity. Furthermore, they could plot absolute values of BNP, rather than the log of BNP, because an ROC curve does not depend on the scale used.1 Berger R, Huelsman M, Strecker K, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. 2002; 105: 2392–2397.LinkGoogle Scholar2 McNeil BJ, Keller E, Adelstein SJ. Primer on certain elements of medical decision making. N Engl J Med. 1975; 293: 211–215.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Pan X, Wu H, Zhou Y, Song L, Zhai W, You S, Hu W and Cao Y Higher NT-proBNP Levels are Related to Poor Functional Outcome and Pneumonia in Acute Intracerebral Hemorrhage Patients, Current Neurovascular Research, 10.2174/1567202620666221020150724, 19:4, (391-397) Malberg H, Wessel N, Bauernschmitt R, Zaunseder S, Kurths J and Bretthauer G (2011) Kardiovaskuläre Variabilitätsanalysen zur Risikostratifizierung nach Herzoperationen, at - Automatisierungstechnik, 10.1524/auto.2011.0957, 59:11, (669-682), Online publication date: 1-Nov-2011. Gastelurrutia P, Pascual-Figal D, Vazquez R, Cygankiewicz I, Shamagian L, Puig T, Ferrero A, Cinca J, de Luna A and Bayes-Genis A (2011) Obesity paradox and risk of sudden death in heart failure, American Heart Journal, 10.1016/j.ahj.2010.10.018, 161:1, (158-164), Online publication date: 1-Jan-2011. Pascual-Figal D, Ordoñez-Llanos J, Tornel P, Vázquez R, Puig T, Valdés M, Cinca J, de Luna A and Bayes-Genis A (2009) Soluble ST2 for Predicting Sudden Cardiac Death in Patients With Chronic Heart Failure and Left Ventricular Systolic Dysfunction, Journal of the American College of Cardiology, 10.1016/j.jacc.2009.07.041, 54:23, (2174-2179), Online publication date: 1-Dec-2009. Piechota M, Banach M, Jacoń A and Rysz J Natriuretic peptides in cardiovascular diseases, Cellular and Molecular Biology Letters, 10.2478/s11658-007-0046-6, 13:2 January 7, 2003Vol 107, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000046777.74753.F8PMID: 12515766 Originally publishedJanuary 7, 2003 PDF download Advertisement