Accuracy of B‐type natriuretic peptide levels in the diagnosis of left ventricular dysfunction and heart failure: A systematic review

Abstract

Objectives: To evaluate the accuracy of B-type natriuretic peptide levels (BNP) in the diagnosis of heart failure and left ventricular dysfunction. Data sources: Electronic search in Medline, Embase, Cochrane Library and Medion database, and hand search of reference lists. Review methods: We have included published studies on the accuracy of BNP which had both sufficient information to construct the 2 Â 2 diagnostic cross table and an appropriate spectrum of patients. Results: Fifty five studies (16,730 patients) were analyzed. The main determinants of diagnostic accuracy were the reference standard analyzed (clinical heart failure versus left ventricular dysfunction), and the methodological quality of the study. BNP levels were highly accurate for the diagnosis of clinical heart failure (diagnostic OR = 41; 95% CI 23 -74). The negative likelihood ratios were homogeneous, and useful for excluding the existence of heart failure (pooled negative likelihood ratio = 0.11; 95% CI 0.08 -0.16). The studies focused on the identification of left ventricular dysfunction were heterogeneous, with indications of publication bias, and showed less overall diagnostic accuracy than studies focused on heart failure. Conclusions: BNP levels are useful for ruling out heart failure. The accuracy of BNP for identifying patients with systolic dysfunction is more limited.

Distinguishing Cardiac and Noncardiac Dyspnea in 48 Dogs Using Plasma Atrial Natriuretic Factor, B‐Type Natriuretic Factor, Endothelin, and Cardiac Troponin‐I

“…1,2 In humans, plasma atrial natriuretic peptide (ANP) and BNP concentrations can be used to predict disease severity, to predict mortality, to monitor therapy, and to identify patients with asymptomatic left ventricular dysfunction. 3,4 Similar roles have been proposed for plasma ET-1 concentrations in both people and companion animals. [5][6][7] In dogs with heart disease, plasma cardiac troponin I (cTnI) concentration, which is a sensitive and specific indicator of ischemic myocardial damage, is increased and reflects the severity of myocardial injury.…”

Natriuretic peptides in the diagnosis and management of heart failure

“…7,33 Latour-Perez and colleagues identified 25 studies of adequate quality examining the ability of BNP to identify systolic dysfunction. 33 The studies were clinically heterogeneous in the types of patients studied, in the BNP cut points used and in the definition of systolic dysfunction. The summary diagnostic odds ratio showed strong evidence of statistical heterogeneity and evidence of publication bias.…”

NT-proB natriuretic peptide, risk factors and asymptomatic left ventricular dysfunction: Results of the SCReening Evaluation of the Evolution of New Heart Failure Study (SCREEN-HF)

“…The natriuretic peptides, NT-proB type natriuretic peptides (NT-proBNP) and B type natriuretic peptide (BNP), use is well established in HF diagnosis [23][24][25] and prognosis [26,27], and they are increasingly being used in HF management [28][29][30]. Their role in screening strategies is encouraging [20,21,31], but the interpretation of natriuretic peptide levels for an individual can be limited by their interactions with other co-morbidities. Focusing screening strategies within high risk populations is one potential, but further investigation to understand the relationships between NT-proBNP, risk factors and patient characteristics is needed.…”