Accuracy of B-natriuretic peptide for the diagnosis of decompensated heart failure in muscular dystrophies patients with chronic respiratory failure

Paris Meng, Lee S Nguyen, Firas Jabbour, Adam Ogna, Bernard Clair, David Orlikowski, Djillali Annane, Frederic Lofaso, Abdallah Fayssoil, Paris Meng, Lee S Nguyen, Firas Jabbour, Adam Ogna, Bernard Clair, David Orlikowski, Djillali Annane, Frederic Lofaso, Abdallah Fayssoil

Abstract

Heart failure and restrictive respiratory insufficiency are complications in muscular dystrophies. We aimed to assess the accuracy of the B-natriuretic peptide (BNP) for the diagnosis of decompensated heart failure in muscular dystrophy. We included patients with muscular dystrophy and chronic respiratory insufficiency admitted in the Intensive Care Unit of the Raymond Poincare hospital (Garches, France) for suspected decompensated heart failure. Thirtyseven patients were included, among them, 23 Duchenne muscular dystrophy (DMD) (62%), 10 myotonic dystrophy type 1(DM1) (27%). Median age was 35 years [27.5; 48.5]. 86.5% of patients were on home mechanical ventilation (HMV). Median left ventricular ejection fraction (LVEF) was 47% [35.0; 59.5]. Median BNP blood level was 104 pg/mL [50; 399]. The BNP level was significantly inversely associated with LVEF (r= -0.37, p 0.03) and positively associated with the LVEDD (left ventricular end diastolic diameter) (r=0.59, P<0.001). The discriminative value of the BNP level for the diagnosis of decompensated heart failure was high with an AUROC=0.94 (P<0.001). The best discriminating BNP threshold was 307 pg/mL (Youden index 0.85). The BNP level measurement may add a supplemental key for the final diagnosis of decompensated heart failure.

Keywords: BNP; heart failure; muscular dystrophy.

Conflict of interest statement

Conflict of interest: the authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
Association between BNP level and LVEF using linear regression (solid line). The dotted lines represent the 95% confidence band of the best-fit line. BNP, brain natriuretic peptide; LVEF, left ventricular ejection fraction.
Figure 2.
Figure 2.
Association between BNP level and EDLVD using linear regression (solid line). The dotted lines represent the 95% confidence band of the best-fit line. BNP, brain natriuretic peptide; EDLVD, end diastolic left ventricular diameter.
Figure 3.
Figure 3.
ROC curve for the accuracy of BNP in the diagnosis of decompensated heart failure in patients with muscular dystrophies. ROC, receiver operating characteristic; BNP, brain natriuretic peptide.

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