PURPOSE: To determine the correlation between objectives findings on AP-CXR with admission brain natriuretic peptide (BNP) levels, ejection fraction (EF) and diastolic dysfunction (DD) in patients presenting with and without dyspnea.
METHODS: Retrospective consecutive chart review of patients presenting with and without dyspnea in whom a concurrent serum BNP and AP-CXR was obtained on admission in 105 consecutive patients over 2 months. EF and DD was assessed in those with recent echocardiogram (within 2 months). Patients with serum creatinine 2 gm/dl were excluded.
RESULTS: 61 (58%) had dyspnea (Group 1) and 44 (42%) had no dyspnea (Group 2). In a multivariate model, after adjusting for age, gender and serum creatinine CTR remained an independent predictor of serum BNP (r=0.63, p < 0.0001) and (r = 0.5, p = 0.003) in group 1 and group 2, respectively. For serum BNP level of >230, the area under the receiver operating characteristics-curve was 0.87 (95% confidence interval 0.79 0.96) for group 1 and 0.78 (95% confidence interval 0.6 0.95) for group 2. A CTR > 0.6 strongly correlated with serum BNP in both groups (Table 1). Correlation between CTR with EF and DD were only weak (r = −0.46 and r =0.37, respectively).
CONCLUSION: CTR > 0.6 is an independent predictor of elevated BNP levels regardless of symptoms. Further, in the presence of dyspnea, CTR > 0.6 predicts a significantly higher BNP.
CLINICAL IMPLICATIONS: Predicting higher BNP levels using CTR on admission CXR may facilitate an earlier diagnostic and therapeutic intervention in the ED, especially in cases where obtaining serum BNP may be delayed.
DISCLOSURE: Ather Anis, No Financial Disclosure Information; No Product/Research Disclosure Information