nt-probnp在慢性心力衰竭中的应用-中国专家共识_廖玉华演示幻灯片.pptVIP

In this study, following enrollment, extensive clinical data were collected, including results of diagnostic studies. In order to ascertain clinical accuracy for the diagnosis of heart failure, the managing ED physician was asked—following completion of evaluation—for their estimate of the presence of heart failure. Studies suggest optimal modality of use for NT-proBNP in primary care is to harness its excellent negative predictive value (NPV). In general, the optimal range to rule out HF is suggested to be 100–160 ng/L (NPV 92%–100%), although some degree of age-related difference in cut-points has been suggested. In younger patients, as noted, 125 ng/mL has excellent negative predictive value, which means that for younger patients below this value, the likelihood for heart failure is very low. Breaking the data out in an even more granular manner, younger patients (such as those 50 years) might be better served by a cut-point of 50 ng/L, while in middle aged patients, a cut-point of 75 ng/L may be even more useful than 125 ng/L, however these cut-points are not yet proven. As the mean value of NT-proBNP in elders is 150 ng/L, it is obvious that a higher cut-point for use in this population is needed. Accordingly, a higher cut-point of 450 ng/L for the elderly has been approved, although 250-300 ng/L may be more useful for this population to exclude heart failure. Turning our attention to the application of NT-proBNP testing for prognostication in chronic heart failure, many considerations as in acute heart failure prognosis hold here as well. First off—prognostication in chronic heart failure may be challenging, with many patients demonstrating higher risk features, but having rather benign courses. Traditionally, variables used to predict risk include age, cardiac function, parameters of renal disease, as well as more complex data points, such as maximal oxygen consumption. As in acute heart failure prognostication, NT-proBNP has been routinely shown to