Comparison of Brain Natriuretic Peptide (BNP) and Amino-Terminal ProBNP for Early Diagnosis of Heart Failure

Emdin, Michele; Passino, Claudio; Prontera, Concetta; Fontana, Marianna; Poletti, Roberta; Gabutti, Alessandra; Mammini, C.; Giannoni, Alberto; Zyw, Luc; Zucchelli, Giuseppe; Clerico, Aldo

doi:10.1373/clinchem.2006.080234

Cited by 71 publications

(67 citation statements)

References 37 publications

(30 reference statements)

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“…17,18 We found similar accuracy, sensitivity, and specificity levels to those reported by Maisel et al 18 at the optimum cutoff point of 265 pg/mL. This reflects the findings by Emdin et al 28 that BNP cutoff concentrations are significantly dependent on the study population and the type of BNP assay used.…”

Section: Discussionsupporting

confidence: 88%

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

Lokuge

Lam

Cameron

et al. 2010

Circ: Heart Failure

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Background-It is often difficult to diagnose heart failure (HF) accurately in patients presenting with dyspnea to the emergency department (ED). This study assessed whether B-type natriuretic peptide (BNP) testing in these patients improved the accuracy of HF diagnosis. Methods and Results-Patients presenting to the Alfred and the Northern Hospital EDs with a chief complaint of dyspnea were enrolled prospectively from August 2005 to April 2007. Patients were randomly allocated to have BNP levels tested or not. The diagnostic gold standard for HF was determined by 1 cardiologist and 1 emergency or respiratory physician who, blinded to the BNP result, independently reviewed all available information. The ED diagnosis of HF in the non-BNP group showed a sensitivity, specificity, and accuracy of 65%, 92%, and 81%, respectively. The BNP group had a similar sensitivity, specificity, and accuracy of 66%, 90%, and 78%, respectively, for the diagnosis of HF in the ED. There was no significant difference between the BNP and non-BNP groups in any of the measures of diagnostic accuracy for HF. Conclusion-In the clinical setting of EDs, availability of BNP levels did not significantly improve the accuracy of a diagnosis of HF.

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Section: Discussionsupporting

confidence: 88%

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

Lokuge

Lam

Cameron

et al. 2010

Circ: Heart Failure

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“…Interestingly, only in men were cTnI values significantly associated with NT-proBNP (the statistical significance found is probably due only to the group with cTnI > 5.2 ng/L). These data suggest that cardiac structural and functional changes (probably related to co-morbidities such as hypertension, diabetes and renal dysfunction), mirrored by increased NT-proBNP concentration, are present in some asymptomatic volunteers of both genders with higher cTnI concentrations (>5.2 ng/L) [143].…”

Section: Clinical Relevance Of Gender-specific Decision Values For Ctmentioning

confidence: 79%

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Clerico

Zaninotto

Ripoli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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According to recent international guidelines, including the 2012 Third Universal Definiton of Myocardial Infarction by the Joint ESC/ACCF/AHA/WHF Task Force, an increase in cardiac troponin (cTn) levels over the 99th percentile upper reference limit (99th URL) should be considered clinically relevant, this cut-off being measured with an imprecision ≤10 CV%. In theory 99th URL values strongly depend not only on demographic and physiological variables (i.e. criteria for considering the reference population "healthy"), but also on the analytical performance of cTn methods and mathematical algorithms used for the calculation. The aim of the present article was therefore to review the methodological and pathophysiological factors affecting the evaluation and calculation of the 99th URL for cTn assay. The critical analysis made showed that no uniform procedure is followed, and nor have experts or regulatory bodies provided uniform guidelines for researchers or cTn assays manufacturers as an aid in "their quest to define normality". In particular, little attention has been paid to the way in which a healthy reference population is to be selected, or the criteria for calculating the 99th URL value for cTn assays, thus highlighting the need for international recommendations not only for demographic and physiological variables criteria for defining a healthy reference population, but also for calculating mathematical algorithms for establishing/ calculating clinical decision values. An expert consensus group, comprising laboratory and clinical scientists, biomedical statisticians, industrial and regulatory representatives, should be responsible for drawing up these guidelines.

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“…12,13 Among these, brain natriuretic peptide (BNP) and the N-terminal fragment of BNP precursor (NT-proBNP) in serum have been known as the gold standard to identify HF and widely utilized in clinical laboratories. [14][15][16] BNP and NT-proBNP are the products of proteolytic processing of the precursor proBNP (pre-proBNP). The removal of signal peptide from preproBNP results in proBNP molecule, which is further split into BNP (biologically active molecule) and NT-proBNP (inactive amino terminal fragment).…”

Section: Introductionmentioning

confidence: 99%

Improved LFIAs for highly sensitive detection of BNP at point-of-care

Gong¹,

Hu²,

Choi³

et al. 2017

IJN

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Heart failure (HF) has become a major cause of morbidity and mortality with a significant global economic burden. Although well-established clinical tests could provide early diagnosis, access to these tests is limited in developing countries, where a relatively higher incidence of HF is present. This has prompted an urgent need for developing a cost-effective, rapid and robust diagnostic tool for point-of-care (POC) detection of HF. Lateral flow immunoassay (LFIA) has found widespread applications in POC diagnostics. However, the low sensitivity of LFIA limits its ability to detect important HF biomarkers (e.g., brain natriuretic peptide [BNP]) that are normally present in low concentration in blood. To address this issue, we developed an improved LFIA by optimizing the gold nanoparticle (GNP)–antibody conjugate conditions (e.g., the conjugate pH and the amount of added antibody), the diameter of GNP and the concentration of antibody embedded on the test line and modifying the structure of test strip. Through these improvements, the proposed test strip enabled the detection of BNP down to 0.1 ng/mL within 10–15 min, presenting ~15-fold sensitivity enhancement over conventional lateral flow assay. We also successfully applied our LFIA in the analysis of BNP in human serum samples, highlighting its potential use for clinical assessment of HF. The developed LFIA for BNP could rapidly rule out HF with the naked eye, offering tremendous potential for POC test and personalized medicine.

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Comparison of Brain Natriuretic Peptide (BNP) and Amino-Terminal ProBNP for Early Diagnosis of Heart Failure

Abstract: Background:We compared the diagnostic accuracy of brain natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) for diagnosis of preclinical and mild heart failure (HF).

Cited by 71 publications

References 37 publications

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Improved LFIAs for highly sensitive detection of BNP at point-of-care

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