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.
BACKGROUND
We used evidence-based laboratory medicine principles to compare the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) assays for the diagnosis of heart failure.


METHODS
In May 2006, we performed a computerized literature search of the online National Library of Medicine to select studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays. The comparison took into account the area under the curve and diagnostic odds ratio (DOR) derived from ROC analysis of original studies.


RESULTS
Both BNP and NT-proBNP assays were found to be clinically useful for the diagnosis of heart failure. Metaanalysis of these data was difficult because of the heterogeneity of data regarding patient population, diagnostic criteria, end-points, and immunoassay methods for both BNP and NT-proBNP. Separate metaanalyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic DOR for BNP (8.44, 95% CI 4.66-15.30) was not significantly different from that of NT-proBNP (23.36, 95% CI 9.38-58.19). In patients with acute heart failure, the mean DOR for BNP (16.46, 95% CI 10.65-25.43) was not significantly different from that of NT-proBNP (18.61, 95% CI 12.99-26.65).


CONCLUSIONS
Our results indicate that both BNP and NT-proBNP assays have a high degree of diagnostic accuracy and clinical relevance for both acute and chronic heart failure.
Clerico
Aldo
A
Laboratory of Cardiovascular Endocrinology, Department of Cardiovascular Medicine, Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy. clerico@ifc.cnr.it
Fontana
Marianna
M
Zyw
Luc
L
Passino
Claudio
C
Emdin
Michele
M
D000208:Acute Disease; D002908:Chronic Disease; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D007118:Immunoassay; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain