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• Cutoff values for B-type Natriuretic Peptides in the Korean patients visiting emergency departments
  Sunghyuk Choi
  Published on: 29 April 2016
• Cutoff values for B-type Natriuretic Peptides in the Korean Population
  Justin A Woods
  Published on: 29 April 2016

• Published on: 29 April 2016

  Cutoff values for B-type Natriuretic Peptides in the Korean patients visiting emergency departments

  • Sunghyuk Choi, M.D.,PhD

  Thanks for your concern and opinion about our article. To determine the influence of underlying diseases on the BNP values, this survey was performed the non-CHF patients only. Therefore, the patients who had myocardical dysfunction caused by sepsis was excluded in this survey. In discussion, it was described that BNP values were increased in the patients of hypertension more than non-hypertension patients due to increas...

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  Thanks for your concern and opinion about our article. To determine the influence of underlying diseases on the BNP values, this survey was performed the non-CHF patients only. Therefore, the patients who had myocardical dysfunction caused by sepsis was excluded in this survey. In discussion, it was described that BNP values were increased in the patients of hypertension more than non-hypertension patients due to increasement of lt-ventricle mass index. Therefore we agree with your opinion. Underlying diseases (COPD, HTN, et al) were diagnosed at the time of discharge, and so we hardly miss. This study was conducted on dyspnea patients not healthy people. We think the target of study was different from your opinion. Nevertheless, it will be better if further study is done with large population of patients.

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Cutoff values for B-type Natriuretic Peptides in the Korean Population

  • Justin A Woods, Spr Anaesthetics & ITU
  • Other Contributors:
    • Gordon Sarah, Anderson Peter

  Dear Sirs,

  We would like to thank the authors for their contribution to the debate concerning the diagnostic use of natriuretic peptides. As a component of an integrated diagnostic scheme1 their further insight into variations in levels is helpful however some clarification is required and that the results should be interpreted with a degree of circumspection. Choi et al have separated their patients into two c...

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  Dear Sirs,

  We would like to thank the authors for their contribution to the debate concerning the diagnostic use of natriuretic peptides. As a component of an integrated diagnostic scheme1 their further insight into variations in levels is helpful however some clarification is required and that the results should be interpreted with a degree of circumspection. Choi et al have separated their patients into two cohorts, in those without underlying disease a significant and important group with pneumonia and sepsis were included. The reported mean value could be biased by the inclusion of this group as myocardial dysfunction due to sepsis causes raised levels of natriuretic peptides and can be used to differentiate survivors and non-survivors.(1,2) They also have not reported if there were any echocardiographic changes of left ventricular hypertrophy or right ventricular dysfunction, in either cohort, which could be associated with minor or moderate increases in BNP. In the subset of patients with hypertension, diabetes and angina they fail to comment on the presence of left ventricular dysfunction where concentrations of BNP may overlap normal concentrations2. In addition the lack of an admission diagnosis of chronic obstructive pulmonary disease (COPD) is relevant as exacerbations of COPD are frequently missed in the emergency department1. The other issue to be considered is that natriuretic peptide levels may be increased in the population before the onset of detectable and significant cardiovascular disease(3). In view of the potential bias, caution is urged when interpreting these results and applying them to a population. Further investigation and characterisation of BNP levels in the Korean population on a large scale basis would be invaluable and in the interim no alteration in the current diagnostic levels should be enacted until this has been done.

  References:

  1) Phua, J; Lim, Tow K; Lee, Kang H B-type natriuretic peptide: Issues for the intensivist and pulmonologist [Review Articles] Critical Care Medicine:Volume 33(9)September 2005pp 2094 -2013

  2) de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003;362:316-322.

  3) Wang TJ, Larson MG, Levy D, et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004;350:655-663

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  Conflict of Interest:
  None declared.

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