The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea ( J Intern Med 2005;258:77–85) - reply
Article first published online: 17 JAN 2006
Journal of Internal Medicine
Volume 259, Issue 2, page 217, February 2006
How to Cite
Mueller, C. (2006), The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea ( J Intern Med 2005;258:77–85) - reply. Journal of Internal Medicine, 259: 217. doi: 10.1111/j.1365-2796.2006.01606.x
- Issue published online: 17 JAN 2006
- Article first published online: 17 JAN 2006
We fully agree with Dr Jolobe that radiographic stigmata of acute heart failure are important in the diagnosis of patients with acute dyspnoea. Obviously, chest X-ray had an integral part in the diagnosis and management of patients in both groups in the BASEL study . However, it is important to point out three details. First, chest X-ray is only moderately accurate in the diagnosis of acute heart failure [2, 3]. Radiographic findings of acute heart failure are specific, but only moderately sensitive [2, 3]. Secondly, B-type natriuretic peptide (BNP) levels provide complementary diagnostic information to the clinical investigation and chest X-ray . BNP levels >100 pg mL−1 contribute significantly to the prediction of heart failure over each of the radiographic indicators . Thirdly, when used in conjunction with the clinical evaluation and chest X-ray, the use of BNP levels improves the management of patients with acute dyspnoea .
Although the clinical and radiographic response to diuretic and vasodilator therapy can at times be very helpful in the diagnosis, this ‘try and error’ strategy seems to be only a second-line approach to me.