Is B-type natriuretic peptide a better prognostic indicator than clinical assessment?
The clinical diagnosis of heart failure (HF) may be difficult (1), and may pose a particular challenge in patients presenting with acute shortness of breath (SOB) in the emergency department (ED). Elements of clinical history and physical examination as well as information obtained from the electrocardiogram and chest radiograph, may provide valuable clues as to whether HF is the cause of symptoms in the acutely dyspneic patients (2). Additional diagnostic tests, including echocardiography, may be required to obtain a more definite diagnosis. The ED, however, is not an optimal setting for echocardiography. Many patients are very ill and may have difficulties in lying still. A considerable proportion of dyspneic patients may be obese or have chronic obstructive pulmonary disease; these factors tend to reduce image quality. Moreover, echocardiography may not be generally available on a 24-h basis in all hospitals. B-type natriuretic peptide (BNP) was first identified in the porcine brain
