Published ahead of print on July 13, 2006, doi:10.1164/rccm.200603-380OC Am. J. Respir. Crit. Care Med., Volume 174, Number 9, November 2006, 990-996 A more recent version of this article appeared on November 1, 2006
Submitted on March 15, 2006 Left Heart Dysfunction and Severe Exacerbation of COPD: Diagnostic Performance of Cardiac BiomarkersFekri Abroug1*,1 Intensive Care Unit, CHU F.Bourguiba, Monastir, Tunisia, 2 Department of Cardiology, CHU F.Bourguiba, Monastir, Tunisia, 3 Biochemistry Laboratory, CHU F.Bourguiba, Monastir, Tunisia * To whom correspondence should be addressed. E-mail: f.abroug{at}rns.tn.
Rationale : cardiac biomarkers have good performance to distinguish acute dyspnea due to left heart dysfunction from that of pulmonary origin. However, they have not been assessed in the specific setting of acute exacerbation of COPD (AECOPD) where they might be released without left heart impairment. Objectives: to assess the accuracy of Troponin T and NT-proBNP dosage in the diagnosis of AECOPD associated with left ventricular (LV) dysfunction. Methods: both biomarkers were measured in 148 consecutive patients upon ICU admission for AECOPD. A panel of physicians adjudicated blindly the cause of AECOPD to be unlikely, possibly or definitely associated with LV dysfunction. Measurements and main results: the final diagnosis was AECOPD definitely associated with acute left heart dysfunction in 31.1%, possibly associated with LV dysfunction in 13.5% and unlikely associated with LV dysfunction in 55.4%. Both NT-proBNP and Troponin T levels were statistically different among the three groups. The area under receiver-operating-characteristics curve was greater for NT-proBNP (0.95 vs 0.67). A cut-off of 1000pg/ml was accurate to rule-out left heart involvement in AECOPD (sensitivity: 94%, negative predictive value: 94%, negative likelihood ratio=0.08). A cut-off of 2500pg/ml had the best operating characteristics to rule-in the diagnosis (positive likelihood ratio: 5.16). Left heart involvement in AECOPD was the only variable independently associated with an increased secretion of NT-proBNP (Odds ratio: 74; 95%CI: 15-375; p=0.0001). Conclusion: NT-proBNP and Troponin T are useful in excluding AECOPD associated with left ventricular dysfunction. NT-proBNP was more accurate. Key words: COPD, exacerbation, BNP, Troponin, left ventricular dysfunction
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