Comparative sensitivities between different plasma B-type natriuretic peptide assays in patients with minimally symptomatic heart failure.
Plasma B-type natriuretic peptide (BNP) assays have become widely used to diagnose and manage patients with heart failure. However, differences in assay characteristics may have important implications when BNP is used as a screening test for heart failure at a specific cutoff value. We performed a prospective comparison of 2 commercially available assays--one that is a laboratory-based, microparticle enzyme immunoassay (MEIA) that uses EDTA plasma specimens and one that is a point-of-care (POC), single-use fluorescence immunoassay that uses EDTA--anticoagulated whole blood or plasma specimens-in patients with heart failure and healthy controls. Despite the overall concordance between different SNP assays for the diagnosis of heart failure, their sensitivities may differ when compared at the approved diagnostic cutoff value of 100 pg/mL. At this cutoff value, the MEIA on AxSYM demonstrated greater sensitivity than POC Triage BNP assay in minimally symptomatic patients with heart failure. Therefore, for screening purposes, cutoff values for plasma BNP or N-terminal pro-BNP levels should be specific for each assay to optimize test performance. These findings suggest that there is a relationship between the decision statistics used in screening for left ventricular dysfunction and the type of diagnostic assay used.
Tang
W H Wilson
WH
Department of Cardiovascular Medicine, Section of Heart Failure and Cardiac Transplantation Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. tangw@ccf.org
Philip
Kiran
K
Hazen
Stanley L
SL
Stevenson
Cindy E
CE
Pepoy
Michael
M
Neale
Sarah
S
Francis
Gary S
GS
Van Lente
Frederick
F
Smith
Andrew
A
Wu
Alan H B
AH
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007124:Immunoenzyme Techniques; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain