Validation of the BREST score for diagnosing acute heart failure in emergency department patients with dyspnea: added value of NT-proBNP and biomarkers.
- 1Department of Emergency Medicine, Gaziantep City Hospital, Gaziantep, Türkiye. [email protected].
- 2Department of Emergency Medicine, Gaziantep Islam Science and Technology University, Gaziantep City Hospital, Gaziantep, Türkiye.
Abstract
Study objective
Acute heart failure (AHF) represents a leading cause of dyspnea among patients presenting to the emergency department (ED), necessitating timely diagnostic approaches. The BREST score is a pragmatic bedside tool developed to support the early identification of AHF using clinical and electrocardiographic findings. This study aimed to prospectively validate the diagnostic performance of the BREST score and assess the incremental diagnostic value of NT-proBNP and selected inflammatory biomarkers.Methods
This study prospectively enrolled consecutive adult patients presenting with dyspnea to the ED of Gaziantep City Hospital between January 2024 and May 2025. At presentation, BREST score components were recorded using standardized clinical forms. Biomarker levels, including NT-proBNP, C-reactive protein (CRP), procalcitonin (PCT), and neutrophil-to-lymphocyte ratio (NLR), were collected during routine diagnostic evaluation. The diagnosis of AHF was established by board-certified cardiologists, blinded to the BREST score, through adjudication of echocardiographic findings, laboratory data (including NT-proBNP), and clinical documentation. Diagnostic accuracy was assessed using sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUC).Results
Among 1215 screened patients, 1000 were included in the final analysis. The median age was 68 years (IQR: 59-76), and 48% were male. AHF was diagnosed in 736 patients (73.6%) based on the reference standard. At the optimal BREST cut-off (≥ 5), the score yielded an AUC of 0.874 (95% CI: 0.849-0.900), with 93.8% sensitivity and 69.3% specificity. The addition of NT-proBNP improved the AUC to 0.895 (95% CI: 0.873-0.917), while the full biomarker panel provided no significant additional benefit (AUC: 0.898). In subgroup analysis, the BREST score retained good discrimination in de novo heart failure (AUC 0.824) and performed strongly in known chronic heart failure (AUC 0.943); this difference indicates that its diagnostic performance is not identical across presentation types.Conclusion
This prospective validation demonstrated that the BREST score is an accurate and efficient diagnostic tool for AHF in ED patients presenting with dyspnea. Its reliance on readily available clinical and ECG data supports its integration into routine ED workflows. Adding NT-proBNP produced a modest, non-significant numerical increase in discrimination, which may still be clinically useful in cases of intermediate clinical probability, while other inflammatory biomarkers added no further value.
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BibTeX
@article{sabrakaak2026validation,
title = {{Validation of the BREST score for diagnosing acute heart failure in emergency department patients with dyspnea: added value of NT-proBNP and biomarkers.}},
author = {Mohammed Malek Sabrakaak and Kazım Ersin Altınsoy},
journal = {BMC emergency medicine},
year = {2026},
month = jul,
doi = {10.1186/s12873-026-01708-3},
url = {https://europepmc.org/article/MED/42972253},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Validation of the BREST score for diagnosing acute heart failure in emergency department patients with dyspnea: added value of NT-proBNP and biomarkers.
AU - Mohammed Malek Sabrakaak
AU - Kazım Ersin Altınsoy
PY - 2026
DA - 2026/07/31
JO - BMC emergency medicine
DO - 10.1186/s12873-026-01708-3
UR - https://europepmc.org/article/MED/42972253
AB - Study objective Acute heart failure (AHF) represents a leading cause of dyspnea among patients presenting to the emergency department (ED), necessitating timely diagnostic approaches. The BREST score is a pragmatic bedside tool developed to support the early identification of AHF using clinical and electrocardiographic findings. This study aimed to prospectively validate the diagnostic performance of the BREST score and assess the incremental diagnostic value of NT-proBNP and selected inflammatory biomarkers.Methods This study prospectively enrolled consecutive adult patients presenting with dyspnea to the ED of Gaziantep City Hospital between January 2024 and May 2025. At presentation, BREST score components were recorded using standardized clinical forms. Biomarker levels, including NT-proBNP, C-reactive protein (CRP), procalcitonin (PCT), and neutrophil-to-lymphocyte ratio (NLR), were collected during routine diagnostic evaluation. The diagnosis of AHF was established by board-certified cardiologists, blinded to the BREST score, through adjudication of echocardiographic findings, laboratory data (including NT-proBNP), and clinical documentation. Diagnostic accuracy was assessed using sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUC).Results Among 1215 screened patients, 1000 were included in the final analysis. The median age was 68 years (IQR: 59-76), and 48% were male. AHF was diagnosed in 736 patients (73.6%) based on the reference standard. At the optimal BREST cut-off (≥ 5), the score yielded an AUC of 0.874 (95% CI: 0.849-0.900), with 93.8% sensitivity and 69.3% specificity. The addition of NT-proBNP improved the AUC to 0.895 (95% CI: 0.873-0.917), while the full biomarker panel provided no significant additional benefit (AUC: 0.898). In subgroup analysis, the BREST score retained good discrimination in de novo heart failure (AUC 0.824) and performed strongly in known chronic heart failure (AUC 0.943); this difference indicates that its diagnostic performance is not identical across presentation types.Conclusion This prospective validation demonstrated that the BREST score is an accurate and efficient diagnostic tool for AHF in ED patients presenting with dyspnea. Its reliance on readily available clinical and ECG data supports its integration into routine ED workflows. Adding NT-proBNP produced a modest, non-significant numerical increase in discrimination, which may still be clinically useful in cases of intermediate clinical probability, while other inflammatory biomarkers added no further value.
SN - 1471-227X
ER -