Use of BNP and NT-proBNP for the diagnosis of heart failure in the emergency department: a systematic review of the evidence

Abstract

Our purpose was to determine the test performance characteristics of BNP and NT-proBNP in the diagnosis of heart failure for patients presenting to an emergency department or urgent care center. We searched Medline, Embase, AMED, Cochrane, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and June 2012. Studies were limited to those using FDA-approved assays. We examined test performance at three pre-specified cutpoints (manufacturers' suggested, researchers' optimal, and lowest) and considered the effect of age, gender, ethnicity and renal function. We used the QUADAS-2 tool to examine risk of bias and applicability, and the AHRQ Methods Guide to assess the strength of evidence. Seventy-six articles met our inclusion criteria, 37 examined BNP, 25 examined NT-proBNP, and 14 examined both. Pooled sensitivity and specificity for BNP at the three pre-specified cutpoints were 95, 91, and 95 % (sensitivity) and 55, 80, and 67 % (specificity), respectively. For NT-proBNP, sensitivity and specificity at the same cutpoints were 91, 90, and 96 % (sensitivity) and 67, 74, and 55 % (specificity). Both BNP and NT-proBNP perform well to rule out, but less well to rule in, the diagnosis of heart failure among persons presenting to emergency departments or urgent care centers. Both BNP and NT-proBNP levels are positively associated with age and negatively associated with renal function. However, the effect of these factors with respect to selecting optimal cutpoints is unclear. For BNP, 100 pg/mL appears to be a consensus cutpoint. No clear consensus has emerged for NT-proBNP, but the age-adjusted cutpoints of 450 pg/mL for <50 years, 900 pg/mL for 50-75 years and 1,800 pg/mL for >75 years appear promising and merit greater scrutiny and validation.

Novel heart failure biomarkers: why do we fail to exploit their potential?

“…Normal levels of natriuretic peptides largely exclude the presence of HF, and therefore levels are particularly useful to rule out HF, especially in the acute setting [1,[27][28][29][30].…”

A Novel Lipid Biomarker Panel for the Detection of Heart Failure with Reduced Ejection Fraction

“…Moreover, the present study aims at improving the diagnostic performance of NT-proBNP by combining it with three specific metabolomic features belonging to the lipid classes of TAGs, SMs, and PCs rather than replacing natriuretic peptides. The resulting biomarker panel, CLP ϩ NT, distinguished HFrEF patients from healthy controls as well as from patients with dyspnea of pulmonary origin, and thus provides several advantages over NT-proBNP alone that have the potential to translate into clinical benefits: First, application of NT-proBNP as a single biomarker for large-scale screening is limited primarily by insufficient specificity, resulting in a high false positive rate or low positive predictive value (4,5,20,21 ). At the chosen cutoff value, CLP ϩ NT shows strongly increased specificity compared to NT-proBNP alone at comparable sensitivity.…”

B-type natriuretic peptide is a useful biomarker predicting disease severity in children with isolated bronchiolitis in the emergency department

“…5 The principal clinical reason for measuring BNP level is that a normal level rules out heart failure in an emergency setting. 6,7 Only a few studies have evaluated serum BNP levels in bronchiolitis patients. These studies focused on detection of heart failure in children with bronchiolitis and congenital heart disease.…”