English
Heart failure (HF) is a substantial global burden, with prevalence rising steadily across regions due to aging populations, improved survival from cardiovascular events and with cardiovascular diseases, and rising prevalence of cardiometabolic risk factors.1,2 Because HF symptoms are non-specific, overlapping with other common respiratory and cardiac conditions, the initial clinical picture can be ambiguous—especially in acute settings.
During acute HF, levels of B-type natriuretic peptide (BNP) and amino-terminal proprotein (NT-proBNP) increase in direct proportion to myocardial stress. In a recent prospective, multicenter, age-stratified study, investigators evaluated the Access NT‑proBNP immunoassay for emergency department (ED) patients presenting with acute dyspnea.3 The Prospective Diagnostic and Risk Evaluation of NT‑proBNP in Clinical Emergency Heart Failure Settings (PRECISE‑HF) study assessed the assay’s performance to aid in identifying acute HF and predicting short‑term cardiovascular outcomes.
Key Study Findings:
- Diagnostic accuracy for acute HF: area under the receiver operating characteristic curve (AUC) = 0.87 (95% CI 0.86–0.88; P<0.001), suggesting that the assay may provide clinically useful information to aid in ruling in or ruling out acute HF in the ED
- Rule-out confidence: 96% clinical sensitivity and 95% negative predictive value (NPV) at a <300 ng/L cutoff value
- Performance relative to a reference method: In a subset of the cohort suitable for between-method comparison, the Access NT-proBNP assay showed diagnostic performance similar to that of the Elecsys proBNP II assay (AUC 0.8536 vs 0.8562)
- Increasing NT-proBNP levels correlated with greater HF severity and predicted shorter major adverse cardiovascular events (MACE)-free survival
Conclusion
The findings show strong diagnostic performance across age-based cutoffs and a close match to an established comparator assay, suggesting that the new test offers a practical option for quantitative measurement of NT proBNP in ED patients with acute dyspnea to aid in the diagnosis, exclusion, and clinical assessment of suspected acute heart failure, using established decision thresholds.
