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Accuracy of B-Type Natriuretic Peptide Tests to Exclude Congestive Heart Failure
Systematic Review of Test Accuracy Studies
Markus Battaglia, MD, MPH;
Daniel Pewsner, MD;
Peter Jüni, MD;
Matthias Egger, MD, MSc, MFPHM;
Heiner C. Bucher, MD, MPH;
Lucas M. Bachmann, MD, PhD
Arch Intern Med. 2006;166:1073-1080.
Background Congestive heart failure (CHF) is a major public health problem. The use of B-type natriuretic peptide (BNP) tests shows promising diagnostic accuracy. Herein, we summarize the evidence on the accuracy of BNP tests in the diagnosis of CHF and compare the performance of rapid enzyme-linked immunosorbent assay (ELISA) and standard radioimmunosorbent assay (RIA) tests.
Methods We searched electronic databases and the reference lists of included studies, and we contacted experts. Data were extracted on the study population, the type of test used, and methods. Receiver operating characteristic (ROC) plots and summary ROC curves were produced and negative likelihood ratios pooled. Random-effect meta-analysis and metaregression were used to combine data and explore sources of between-study heterogeneity.
Results Nineteen studies describing 22 patient populations (9 ELISA and 13 RIA) and 9093 patients were included. The diagnosis of CHF was verified by echocardiography, radionuclide scan, or echocardiography combined with clinical criteria. The pooled negative likelihood ratio overall from random-effect meta-analysis was 0.18 (95% confidence interval [CI], 0.13-0.23). It was lower for the ELISA test (0.12; 95% CI, 0.09-0.16) than for the RIA test (0.23; 95% CI, 0.16-0.32). For a pretest probability of 20%, which is typical for patients with suspected CHF in primary care, a negative result of the ELISA test would produce a posttest probability of 2.9%; a negative RIA test, a posttest probability of 5.4%.
Conclusions The use of BNP tests to rule out CHF in primary care settings could reduce demand for echocardiography. The advantages of rapid ELISA tests need to be balanced against their higher cost.
Author Affiliations: Department of Social and Preventive Medicine, University of Berne (Drs Battaglia and Egger), MediX General Practice Network, Berne (Dr Pewsner), Basel Institute for Clinical Epidemiology, University Hospital, Basel (Dr Bucher), and Horten Center, University of Zurich, Zurich (Dr Bachmann), Switzerland; and MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, England (Drs Jüni and Egger).
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