NTproBNP在急性呼吸困难患者心衰诊断中的应用--培训课件.ppt

In contrast to an age-independent rule out cut-point, the ICON investigators found that age stratification of the ‘rule in’ cut-point for NT-proBNP yielded superior accuracy compared to a single age independent cut-point. By age stratifying, sensitivity is preserved, while specificity is improved in elders, resulting in a significant rise in positive predictive value, and a shrinking of the number of “grey zone” results. This approach does not imply that NT-proBNP is more dependent on age than is BNP; rather, by age stratifying, results superior to those from BNP may be gained. Another situation that may occur is an NT-proBNP that falls into the “grey zone”. This is defined as an NT-proBNP value that is between the rule out value of 300 ng/L and the age-adjusted rule in value. While age adjustment reduces the likelihood for a grey zone result, it is still present in up to 20% of patients. In order to manage this situation, knowledge of the differential diagnosis of a grey zone NT-proBNP is important. As demonstrated in ICON, the diagnoses associated with a grey zone result included pulmonary diagnoses primarily, as well as non-heart failure cardiac diagnoses. In patients with grey zone results, predictors of a correct diagnosis of heart failure included easily ascertained variables from history and physical examination. Thus, clinical excellence remains important when using natriuretic peptides in order to secure the correct diagnosis when results from these important peptides are less useful for diagnosis. In light of everything that is known about the triggers for NT-proBNP and the clinical associations with NT-proBNP and disease states besides heart failure, the clinician that employs NT-proBNP testing should know the differential diagnosis for elevation of this marker in contexts other than heart failure. This includes many cardiovascular diagnoses, such as coronary ischemia, heart muscle disease, valve disease, heart rhythm abnormalities, congenital hea