Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction

Authors

  • B. Ewald,

    1. 1 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle and 2Northern Rivers Division of General Practice, Lismore, New South Wales, Australia
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  • 1 D. Ewald,

    1. 1 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle and 2Northern Rivers Division of General Practice, Lismore, New South Wales, Australia
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  • 2 A. Thakkinstian,

    1. 1 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle and 2Northern Rivers Division of General Practice, Lismore, New South Wales, Australia
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  • and 1 J. Attia 1

    Corresponding author
    1. 1 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle and 2Northern Rivers Division of General Practice, Lismore, New South Wales, Australia
    • John Attia, Division of Medicine, John Hunter Hospital, Locked Bag 1, Hunter Regional Mail Centre, Newcastle, NSW 2310, Australia.
      Email: john.attia@newcastle.edu.au

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  • Funding: Dr B. E. is a PhD candidate with a scholarship from National Health and Medical Research Council of Australia, Dr D. E. is in private practice and Dr J. A. is a full-time academic.

    Potential conflicts of interest: None

Abstract

Background:  We set out to review the validity of tests for B type natriuretic peptide (BNP) and N-terminal pro BNP (NTproBNP) in the diagnosis of clinical heart failure (HF) in primary care and hospital settings and to examine the effect of age. We also examined the accuracy of the test in population screening for left ventricular systolic dysfunction.

Methods:  Medline and Embase were searched systematically till June 2005. Forty-seven studies were identified for systematic review and 27 were included in meta-analyses. Test performance was summarized as the diagnostic odds ratio (DOR). As a secondary data analysis, this paper does not require ethical approval.

Results:  In groups of symptomatic patients with average age less than 80 years, the summary DOR of 27 for BNP equates to a sensitivity of 85% and specificity of 84% in the detection of clinical HF. Summary of head-to-head studies shows BNP is a better indicator than NTproBNP. The performance of both tests decreased with the age of patients, the DOR declining by a factor of 2.0 for BNP and 2.5 for NTproBNP for each decade of increasing age. BNP correlated better to clinical status than to echocardiographic parameters, and test performance was similar in acute inpatient and general practice settings.

Conclusion:  Tests for BNP are helpful in the diagnosis of clinical HF or in screening for left ventricular systolic dysfunction and are superior to NTproBNP. In the clinical setting, test performance declined with increasing patient age.

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