Accuracy of N‐terminal‐pro‐atrial natriuretic peptide in patients admitted to emergency department

Abstract

Objective. B‐type natriuretic peptide (BNP) and N‐terminal‐pro‐BNP (Nt‐proBNP) are commonly used for the triage of patients in the emergency department (ED) with dyspnoea and/or chest pain. The aim of our study was to determine the accuracy of N‐terminal‐pro‐ANP (Nt‐proANP) in such patients. Material and methods. Nt‐proANP was measured by home‐made radioimmunoassay in 137 ED patients admitted with cardiovascular and/or pulmonary disorders. BNP and Nt‐pro‐BNP were determined with automated assays. Final diagnosis was confirmed at discharge or after follow‐up. Results. Nt‐proANP levels were significantly influenced by the diagnostic subgroups (ANOVA: p<0.001) and were [geometric mean (range)]: 19727 ng/L (5260–45200) in congestive heart failure (CHF, n = 31), 6575 ng/L (1350–36000) in coronary artery disease (CAD, n = 19), 5324 ng/L (1710–13150) in pulmonary embolism (PE, n = 20), 5035 ng/L (1510–16600) in pulmonary diseases (PD, n = 24) and 3001 ng/L (750–11860) in patients without cardiopulmonary diseases (n = 43). Pairwise comparisons demonstrated that CHF patients had Nt‐pro‐ANP values higher than all other groups (p<0.05) and that patients without cardiopulmonary diseases had the lowest values (p<0.05). For diagnosis of CHF, the area under the ROC curve of Nt‐proANP was 0.94 (95 % CI: 0.89–0.98) and was equivalent to Nt‐proBNP (0.91; p = 0.284) and BNP (0.93; p = 0.572). Conclusions. The diagnostic accuracy of Nt‐proANP was equivalent to BNP and Nt‐proBNP in the present cohort of patients admitted to ED with dyspnoea and/or chest pain.

• Congestive heart failure
• emergency screening
• immunoassay
• Nt‐proANP
• BNP