This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (86)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Review  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic

Jenny A. Doust, BMBS, FRACGP; Paul P. Glasziou, FRACGP, PhD; Eva Pietrzak, PhD; Annette J. Dobson, PhD

Arch Intern Med. 2004;164:1978-1984.

Background  The diagnosis of heart failure is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Natriuretic peptides have been proposed as a possible test for assisting diagnosis. We assessed the diagnostic accuracy of brain natriuretic peptide (BNP), including a comparison with atrial natriuretic peptide (ANP).

Methods  Electronic searches were conducted of MEDLINE and EMBASE from January 1994 to December 2002 and handsearches of reference lists of included studies. We included studies that assessed the diagnostic accuracy of BNP against echocardiographic or clinical criteria or that compared the diagnostic accuracy of BNP with ANP. Two reviewers assessed studies for inclusion and quality and extracted the relevant data. A meta-analysis was performed by pooling the diagnostic odds ratios for studies that used a common reference standard.

Results  Twenty studies were included. For the 8 studies (n = 4086) that measured BNP against the criterion of left ventricular ejection fraction of 40% or less (or equivalent), the pooled diagnostic odds ratio was 11.6 (95% confidence interval, 8.4-16.1). The pooled diagnostic odds ratio was greater, 30.9 (95% confidence interval, 27.0-35.4), in the 7 studies (n = 2374) that measured BNP against clinical criteria (generally a consensus view using all other clinical information). The diagnostic odds ratio was similar in studies conducted in general practice and in hospital settings. Three studies compared BNP with N-terminal–ANP, a precursor form of ANP, and pooling of the results of these studies showed BNP to be a more accurate marker of heart failure than NT-ANP.

Conclusions  Brain natriuretic peptide is an accurate marker of heart failure. Use of a cutoff value of 15 pmol/L achieves high sensitivity, and BNP values below this exclude heart failure in patients in whom disease is suspected. As the diagnostic odds ratio for BNP is greater when assessed against clinical criteria than against left ejection fraction alone, BNP may also be detecting patients with "diastolic" heart failure.

From the Centre for General Practice (Drs Doust, Glasziou, and Pietrzak) and Division of Epidemiology and Social Medicine (Dr Dobson), School of Population Health, University of Queensland, Herston, Australia. The authors have no relevant financial interest in this article.

RELATED LETTER

Diagnostic Accuracy of Natriuretic Peptides for Heart Failure
Markus Battaglia, Lucas M. Bachmann, and Matthias Egger
Arch Intern Med. 2005;165(6):704.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Relation of N-terminal pro-brain natriuretic peptide levels and their prognostic power in chronic stable heart failure to obesity status
Frankenstein et al.
Eur Heart J 2008;29:2634-2640.
ABSTRACT | FULL TEXT  

B-type natriuretic peptide levels predict outcomes for children on extracorporeal life support after cardiac surgery.
Chikovani et al.
J. Thorac. Cardiovasc. Surg. 2007;134:1179-1187.
ABSTRACT | FULL TEXT  

Role of brain natriuretic peptide (BNP) in risk stratification of adult syncope
Reed et al.
Emerg. Med. J. 2007;24:769-773.
ABSTRACT | FULL TEXT  

Lipoprotein-Associated Phospholipase A2 Predicts 5-Year Cardiac Mortality Independently of Established Risk Factors and Adds Prognostic Information in Patients with Low and Medium High-Sensitivity C-Reactive Protein (The Ludwigshafen Risk and Cardiovascular Health Study)
Winkler et al.
Clin. Chem. 2007;53:1440-1447.
ABSTRACT | FULL TEXT  

Brain Natriuretic Peptide: Clinical and Research Challenges
Carrillo-Jimenez et al.
J CARDIOVASC PHARMACOL THER 2007;12:85-88.
ABSTRACT  

N-Terminal Pro-B-Type Natriuretic Peptide Predicts Total and Cardiovascular Mortality in Individuals with or without Stable Coronary Artery Disease: The Ludwigshafen Risk and Cardiovascular Health Study
Marz et al.
Clin. Chem. 2007;53:1075-1083.
ABSTRACT | FULL TEXT  

Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review
Clerico et al.
Clin. Chem. 2007;53:813-822.
ABSTRACT | FULL TEXT  

Diastolic Dysfunction in Heart Failure With Preserved Systolic Function: Need for Objective Evidence: Results From the CHARM Echocardiographic Substudy-CHARMES
Persson et al.
J Am Coll Cardiol 2007;49:687-694.
ABSTRACT | FULL TEXT  

A Gray Zone Assigned to Inconclusive Results of Quantitative Diagnostic Tests: Application to the Use of Brain Natriuretic Peptide for Diagnosis of Heart Failure in Acute Dyspneic Patients
Coste et al.
Clin. Chem. 2006;52:2229-2235.
ABSTRACT | FULL TEXT  

Association of Left-Heart Dysfunction with Severe Exacerbation of Chronic Obstructive Pulmonary Disease: Diagnostic Performance of Cardiac Biomarkers
Abroug et al.
Am. J. Respir. Crit. Care Med. 2006;174:990-996.
ABSTRACT | FULL TEXT  

Natriuretic peptides in the diagnosis and management of heart failure.
Felker et al.
CMAJ 2006;175:611-617.
ABSTRACT | FULL TEXT  

Rapid Brain Natriuretic Peptide Test and Doppler Echocardiography for Early Diagnosis of Mild Heart Failure
Aspromonte et al.
Clin. Chem. 2006;52:1802-1808.
ABSTRACT | FULL TEXT  

Review: ECG, BNP, and N terminal-pro BNP are more sensitive than specific for chronic left ventricular systolic dysfunction
Doust
Evid. Based Med. 2006;11:117-117.
FULL TEXT  

Collapse query cause: the management of adult syncope in the emergency department.
Reed and Gray
Emerg. Med. J. 2006;23:589-594.
ABSTRACT | FULL TEXT  

Assay for Measurement of Intact B-Type Natriuretic Peptide Prohormone in Blood
Giuliani et al.
Clin. Chem. 2006;52:1054-1061.
ABSTRACT | FULL TEXT  

Accuracy of B-type natriuretic Peptide tests to exclude congestive heart failure: systematic review of test accuracy studies.
Battaglia et al.
Arch Intern Med 2006;166:1073-1080.
ABSTRACT | FULL TEXT  

Serum N-Terminal Brain Natriuretic Peptide as a Prognostic Parameter in Patients With Pulmonary Hypertension
Fijalkowska et al.
Chest 2006;129:1313-1321.
ABSTRACT | FULL TEXT  

B-Type Natriuretic Peptide (BNP) and N-Terminal Pro-BNP in Obese Patients without Heart Failure: Relationship to Body Mass Index and Gastric Bypass Surgery
St. Peter et al.
Clin. Chem. 2006;52:680-685.
ABSTRACT | FULL TEXT  

Alterations in plasma B-type natriuretic peptide levels after repair of congenital heart defects: a potential perioperative marker.
J. Thorac. Cardiovasc. Surg. 2006;131:632-638.
 

Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications
Clerico et al.
Am. J. Physiol. Heart Circ. Physiol. 2006;290:H17-H29.
ABSTRACT | FULL TEXT  

Role of N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification in Patients Presenting in the Emergency Room
Mockel et al.
Clin. Chem. 2005;51:1624-1631.
ABSTRACT | FULL TEXT  

Comparison of a Fully Automated Immunoassay with a Point-of-Care Testing Method for B-Type Natriuretic Peptide
Prontera et al.
Clin. Chem. 2005;51:1274-1276.
FULL TEXT  

Editorial Comment--Brain Natriuretic Peptide and Early Cardiac Dysfunction After Subarachnoid Hemorrhage
Schillinger
Stroke 2005;36:1570-1571.
FULL TEXT  

Brain natriuretic peptide in heart failure: an improving prognosis?
Crook and Smith
Eur Heart J 2005;26:1052-1053.
FULL TEXT  

Human N-Terminal proBNP Is a Monomer
Crimmins
Clin. Chem. 2005;51:1035-1038.
FULL TEXT  

Diagnostic Accuracy of Natriuretic Peptides for Heart Failure--Reply
Doust et al.
Arch Intern Med 2005;165:1199-1199.
FULL TEXT  

Cardiovascular Risk Stratification in Older Patients: Role of Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels
Schillinger
JAMA 2005;293:1667-1669.
FULL TEXT  

Diagnostic Accuracy of Natriuretic Peptides for Heart Failure
Battaglia et al.
Arch Intern Med 2005;165:704-704.
FULL TEXT  

How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review
Doust et al.
BMJ 2005;330:625.
ABSTRACT | FULL TEXT  

BNP for Diagnosing Heart Failure
JWatch Emergency Med. 2004;2004:2-2.
FULL TEXT