Validation of NT-proBNP cutoff points for heart failure diagnosis in adults with CHD in the outpatient clinic and emergency department

Background: Empirical data support the use of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) for heart failure (HF) rule-in and rule-out in patients with acquired heart disease, but similar data are lacking in adults with congenital heart disease (CHD). The purpose of this study was to assess diagnostic performance of conventional NT-proBNP cutoff points for HF diagnosis (rule-in and rule-out) in adults with CHD. Method: Retrospective study of adults with CHD and NT-proBNP measurement in the outpatient clinic (outpatient cohort) or in the emergency department (ED) (2003-2023). HF diagnosis was based on clinical assessment at the time of NT-proBNP measurement. Logistic regression was used to assess the diagnostic performance of conventional NT-proBNP cutoff points (<125 pg/ml for HF rule-out and ≥250 pg/ml for HF rule-in in the outpatient setting; <300 pg/ml for HF rule-out and ≥450 pg/ml for HF rule-in in the ED setting). Results: The outpatient cohort comprised 3961 patients (age 45 ± 16 years), and NT-proBNP <125 pg/ml ruled-out HF with 86% sensitivity, while NT-proBNP level ≥250 pg/ml ruled-in with 68% specificity. The ED cohort comprised 687 patients (age 49 ± 16 years) and NT-proBNP level <300 pg/ml ruled-out HF with 82% sensitivity, and NT-proBNP level ≥450 pg/ml ruled-in HF with 75% specificity. Conclusions: These data support the use of these NT-proBNP levels for HF screening in the CHD population, which in turn would enable early detection and treatment of HF.