Utility of NT-proBNP for Identifying LV Failure in Patients with Acute Exacerbation of Chronic Bronchitis

Qing-Ping Wang,Juan Gu,Li-Ming Mao,Ai-Guo Tang,Xue-Dong Wang,Li-Min Wen,Xiao-Zhi Cao,Ping-Nan Shan,Pal Bela Szecsi

doi:10.1371/journal.pone.0052553

Abstract

BackgroundNT-proBNP has been widely regarded as a useful tool for diagnosis or exclusion of heart failure (HF) in many settings. However, in patients with acute exacerbation of chronic bronchitis (AECB), its roles have not been well described. The objective of this study was to evaluate the diagnostic performance of NT-proBNP for identifying left ventricular (LV) failure in such patients.Methods and Results311 AECB patients and 102 stable chronic bronchitis patients with no history of HF were enrolled. Plasma NT-proBNP concentrations were measured using Roche Elecsys. The European Society of Cardiology (ESC) diagnostic principles were adopted to identify HF and the diagnostic performance of NT-proBNP was evaluated by ROC. Our results showed, the median NT-proBNP level in patients with LV failure [4828.4 (2044.4–9203.6) ng/L] was significantly higher than that in those without LV failure [519.2 (179.1–1409.8) ng/L, p<0.001] and stable controls [207.5 (186.5–318.2) ng/L, p<0.001]. LV failure, renal function, atrial fibrillation and systolic pulmonary artery pressure were independent predictors of NT-proBNP levels (all p<0.05). The area under ROC curve (AUC) of NT-proBNP for identifying LV failure was 0.884, significantly superior to clinical judgment alone (AUC 0.835, p = 0.0294). At the optimal cutoff value of 935.0 ng/L, NT-proBNP yielded sensitivity 94.4%, specificity 68.2%, accuracy 74.3% and negative predictive value 97.6%. Adding the results of NT-proBNP to those of clinical judgment improved the diagnostic accuracy for LV failure.ConclusionAs a tool for diagnosis or exclusion of HF, NT-proBNP can help physicians identify LV failure in patients with AECB.

Highlights

Acute exacerbations of chronic bronchitis (AECB) are episodes of difficulty in breathing in a patient with chronic bronchitis (CB)
Patients hospitalized in a cadre ward with a stable phase of chronic bronchitis but unlikely to be associated with heart failure (HF) were recruited as controls
Echocardiographic examination was performed on the first day of admission and the following parameters were recorded: left ventricular ejection fraction (LVEF), systolic pulmonary pressure (SPAP), early diastolic inflow (E) and late atrial inflow (A) velocities, deceleration time (DT), and LV isovolumetric relaxation time (IVRT)

Summary

Introduction

Acute exacerbations of chronic bronchitis (AECB) are episodes of difficulty in breathing in a patient with chronic bronchitis (CB). They are common causes of morbidity and in patients with concomitant airway obstruction (COPD) are major causes of mortality [1,2,3,4]. Infectious agents (bacterial or viral infection) are estimated to account for around 50–70% of these episodes, non-infectious agents may cause worsening of CB [5]. Of these non-infectious etiologies, heart failure (HF) is a potential trigger for AECB [6,7,8]. The objective of this study was to evaluate the diagnostic performance of NT-proBNP for identifying left ventricular (LV) failure in such patients

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Results

Conclusion