Comparison of BNP and NT-proBNP assays in the approach to the emergency diagnosis of acute dyspnea

Abstract

N-terminal pro-brain natriuretic peptide (NT-proBNP) and BNP measurement could have a significant role in differentiating dyspnea between cardiac or pulmonary origin in the emergency room. The development of new and different commercial assays for these B-type natriuretic peptides offers the possibility of improving and simplifying their measurements but this could be defaulted due to the differences in methodology and the lack of assay standardization. We compared four available methods of measuring NT-proBNP and BNP and evaluated their usefulness in diagnosing the causes of breathlessness in the emergency room. The correlation of BNP with different assays was strong with r>0.98 (P<0.0001). Comparison studies between NT-proBNP and BNP procedures were in good agreement with r>0.87. The area under the receiver-operating characteristic curve (ROC) for BNP or NT-proBNP for detecting any cardiac dysfunction was higher than 0.96 (95% CI). A BNP value of 116 pg/mL measurement with the Access BNP assay (Beckman Coulter Inc., Fullerton, CA), a BNP value of 79 pg/mL with Advia Centaur BNP assay (Bayer Diagnostics, Tarrytown, NY), and an NT-proBNP level of 817 pg/mL in Elecsys NT-proBNP assay (Roche Diagnostic, Mannheim, Germany), showed both high sensitivity (>92%) and high specificity (>93%). We have found that NT-proBNP and BNP present similar diagnostic accuracies for the differential diagnosis of dyspnea.

Comparison of the Utility of Preoperative versus Postoperative B-type Natriuretic Peptide for Predicting Hospital Length of Stay and Mortality after Primary Coronary Artery Bypass Grafting

“…Although both BNP and N-terminal proBNP measurements generally correlate well with each other and both have been used successfully for perioperative risk stratification, the absolute values of BNP and N-terminal proBNP are not interchangeable. 31,32 Furthermore, there is a variability in absolute values of measurements made with various commercially available BNP assays. 33 Thus, although results of this study, particularly with regard to cut-points in peak postoperative BNP, should be considered specific to the BNP assay used in this study, future studies should focus on risk stratification cutoffs for different BNP and N-terminal proBNP assays in both primary CABG and other cardiac surgical cohorts.…”

BNP or NTproBNP? A clinician's perspective

“…All of the used assays showed acceptable analytic performance [11,13,30,31]. Further studies, however, are needed to confirm that the identical cut-off points can be used with the novel assays as validated with the Biosite assay or Roche NTproBNP assay.…”

“…Measurement of NTproBNP/BNP in the emergency department improved the evaluation and treatment of patients with acute dyspnea and reduced the time to discharge and the total cost of treatment [5,7,[92][93][94]. Several studies have reported that NTproBNP and BNP present similar diagnostic accuracies for the differential diagnosis of dyspnea [9][10][11][95][96][97]. Lainchbury et al [1] suggested that differences in sensitivity and specificity may influence the assay choice in this setting.…”

“…Recently, several studies have compared the clinical applications of these biomarkers, including their use as a diagnostic test for the presence of heart failure (HF) in the newly symptomatic patient [1,[9][10][11], for the presence of risk stratification for prognosis after recent cardiac decompensation, in chronic HF [2,[12][13][14], or after acute coronary events [15][16][17][18]; for monitoring and adjusting of therapy in chronic HF [19]; and for screening asymptomatic at-risk populations for significant cardiac impairment [3,20]. Whether the measurement of BNP or NTproBNP offers any advantage over one another in any clinical setting remains controversial.…”

Influence of sample matrix and storage on BNP measurement on the Bayer Advia Centaur

“…BNP is derived from the precursor peptide proBNP, which is cleaved into the inactive amino-terminal fragment (NT-proBNP) comprising the first 76 amino acids of proBNP and the biologically active BNP hormone (BNP 1-32) (2). BNP is constantly elevated in states of increased ventricular wall stress and the measurement of circulating BNP and N-terminal proBNP (NT-proBNP) help to identify and guide the therapy of patients with both acute and chronic heart failure (HF) (3,4) and might also have a significant role in differentiating origin of dyspnea either cardiac or pulmonary in the emergency room (5). Additionally, in patients with chronic HF and acute and chronic coronary syndrome, both elevated BNP and NTpro-BNP are markers of unfavorable prognosis, being associated with increased mortality (6).…”