title: Comparison of brain natriuretic peptide (BNP) and amino-terminal ProBNP for early diagnosis of heart failure.
abstract: BACKGROUND
  We compared the diagnostic accuracy of brain natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) for diagnosis of preclinical and mild heart failure (HF).
  
  
  METHODS
  We assayed plasma NT-proBNP and BNP in 182 healthy controls and in a prospective cohort of 820 HF patients divided according to the American Heart Association/American College of Cardiology classification. These included 86 patients in stage A [mean (SE) ejection fraction 61% (1%); mean (SE) age 47 (2) years], 255 in stage B [65% (2%); 62 (1) years], 420 patients in stage C [35% (1%); 68 (1) years] and 59 in stage D [25% (1%); 74 (1) years]. Diagnostic accuracies of BNP and NT-proBNP were evaluated by ROC analysis, and a multivariate linear regression model was applied to predict HF staging.
  
  
  RESULTS
  Median BNP and NT-proBNP concentrations increased from stage A to D 57-fold and 107-fold, respectively. Both assays were accurate (P <0.001) in separating stage B from controls or stage A, and stage C from controls or stage A or B. NT-proBNP was more accurate (P <0.001) than BNP in differentiating stage C from stages A and B patients and controls and was a better predictor of HF classification in a model including age, sex, and renal function (P <0.001).
  
  
  CONCLUSIONS
  Monitoring BNP or NT-proBNP enabled identification of asymptomatic patients at risk for the development of HF. NT-proBNP showed better accuracy than BNP for identifying mild HF.
authors.affiliation: CNR Institute of Clinical Physiology, Cardiovascular Medicine Department and Cardiovascular Endocrinology Laboratory, Pisa, Italy. emdin@ifc.cnr.it
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Concetta
authors.initials: C
authors.lastname: Prontera
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.forename: Roberta
authors.initials: R
authors.lastname: Poletti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gabutti
authors.forename: Chiara
authors.initials: C
authors.lastname: Mammini
authors.forename: Alberto
authors.initials: A
authors.lastname: Giannoni
authors.forename: Luc
authors.initials: L
authors.lastname: Zyw
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zucchelli
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain