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Comparative value of BNP and NT-proBNP in diagnosis of heart failure.
Rev Port Cardiol. 2004 Jul-Aug; 23(7-8):979-91.RP

Abstract

Heart failure (HF) remains a major diagnostic challenge. Brain natriuretic peptide (BNP) and the N-terminal portion of proBNP (NT-proBNP) have emerged as excellent diagnostic biohumoral indicators in cardiac disease. It is not clear which of the two is superior as a diagnostic marker in HF.

OBJECTIVE

To compare the ability of BNP and NT-proBNP to distinguish subjects with HF from healthy volunteers, as well as to differentiate between HF with left ventricular (LV) systolic dysfunction (SD) and HF with preserved systolic function (PSF).

METHODS

We measured plasma BNP (Shionogi, Osaka) and NT-proBNP (ELECSYS) in 21 healthy individuals (control group [CG]), 11 men, 10 women, mean age 54.4 +/- 11.6 years, with normal ECG and chest X-ray, and in 86 HF patients (HFG), 48 men, 38 women, mean age 71 +/- 11 years, in NYHA II-IV, fulfilling the European Society of Cardiology guidelines: 60 had HF with SD (SDG), ejection fraction (EF) < 40%, and 26 had HF and PSF (PFG), EF > 40%, increased LV mass index and/or dilated left atrium. BNP and NT-proBNP mean and median values were compared and the correlation between the 2 peptides was established. For each peptide sensitivity (sens), specificity (spec) 93.7%, positive predictive value (PPV) 75.5% and negative predictive value (NPV) were calculated. Areas under the ROC curve (AUC) were determined for each group vs. CG and for SDG vs. PFG.

RESULTS

Levels of BNP and NT-proBNP were significantly higher in HF patients, particularly in the SDG, than in healthy subjects. There was reasonable agreement between BNP and NT-proBNP. For BNP, AUC were: HFG vs. CG: 97.7-98.0%; SDG vs. CG: 98.6-99.1%; PFG vs. CG: 95.1-95.9%; PFG vs. SDG: 69.7-70.9%; and for NT-proBNP: HFG vs. CG: 99.2-99.3%; SDG vs. CG: 99.6-99.7%; PFG vs. CG: 98.3-98.5%; PFG vs. SDG: 63.3-63.6%. For a cut-off of 32 pg/ml, BNP has 91.7% sens, 93.7% spec, 75.5% PPV and 98.3% NPV. A NT-proBNP cut-off of 126 pg/ml has 96.3% sens, 98.8% spec, 94.3% PPV and 99.3% NPV.

CONCLUSIONS

Both peptides had an excellent ability to distinguish HF from non-HF subjects. NT-proBNP was more sensitive and specific. Nevertheless, neither peptide could differentiate between the SDG and the PFG by itself. NT-proBNP is a simple, highly effective diagnostic test for HF. A favorable impact on management and costs is expected from implementation of this diagnostic test in clinical practice.

Authors+Show Affiliations

Serviço de Medicina, Unidade de Insuficiência Cardíaca, Serviço de de Patologia Clínica, Hospital de São Francisco Xavier, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal. candidafonseca@netc.ptNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng por

PubMed ID

15478324

Citation

Fonseca, Candida, et al. "Comparative Value of BNP and NT-proBNP in Diagnosis of Heart Failure." Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, vol. 23, no. 7-8, 2004, pp. 979-91.
Fonseca C, Sarmento PM, Minez A, et al. Comparative value of BNP and NT-proBNP in diagnosis of heart failure. Rev Port Cardiol. 2004;23(7-8):979-91.
Fonseca, C., Sarmento, P. M., Minez, A., Gonçalves, E., Covas, R., Dias, A. R., Pina, M. J., & Ceia, F. (2004). Comparative value of BNP and NT-proBNP in diagnosis of heart failure. Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, 23(7-8), 979-91.
Fonseca C, et al. Comparative Value of BNP and NT-proBNP in Diagnosis of Heart Failure. Rev Port Cardiol. 2004 Jul-Aug;23(7-8):979-91. PubMed PMID: 15478324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative value of BNP and NT-proBNP in diagnosis of heart failure. AU - Fonseca,Candida, AU - Sarmento,Pedro M, AU - Minez,Ana, AU - Gonçalves,Elsa, AU - Covas,Ricardo, AU - Dias,Ana Ramos, AU - Pina,Maria Julieta Esperança, AU - Ceia,Fátima, PY - 2004/10/14/pubmed PY - 2005/4/6/medline PY - 2004/10/14/entrez SP - 979 EP - 91 JF - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JO - Rev Port Cardiol VL - 23 IS - 7-8 N2 - UNLABELLED: Heart failure (HF) remains a major diagnostic challenge. Brain natriuretic peptide (BNP) and the N-terminal portion of proBNP (NT-proBNP) have emerged as excellent diagnostic biohumoral indicators in cardiac disease. It is not clear which of the two is superior as a diagnostic marker in HF. OBJECTIVE: To compare the ability of BNP and NT-proBNP to distinguish subjects with HF from healthy volunteers, as well as to differentiate between HF with left ventricular (LV) systolic dysfunction (SD) and HF with preserved systolic function (PSF). METHODS: We measured plasma BNP (Shionogi, Osaka) and NT-proBNP (ELECSYS) in 21 healthy individuals (control group [CG]), 11 men, 10 women, mean age 54.4 +/- 11.6 years, with normal ECG and chest X-ray, and in 86 HF patients (HFG), 48 men, 38 women, mean age 71 +/- 11 years, in NYHA II-IV, fulfilling the European Society of Cardiology guidelines: 60 had HF with SD (SDG), ejection fraction (EF) < 40%, and 26 had HF and PSF (PFG), EF > 40%, increased LV mass index and/or dilated left atrium. BNP and NT-proBNP mean and median values were compared and the correlation between the 2 peptides was established. For each peptide sensitivity (sens), specificity (spec) 93.7%, positive predictive value (PPV) 75.5% and negative predictive value (NPV) were calculated. Areas under the ROC curve (AUC) were determined for each group vs. CG and for SDG vs. PFG. RESULTS: Levels of BNP and NT-proBNP were significantly higher in HF patients, particularly in the SDG, than in healthy subjects. There was reasonable agreement between BNP and NT-proBNP. For BNP, AUC were: HFG vs. CG: 97.7-98.0%; SDG vs. CG: 98.6-99.1%; PFG vs. CG: 95.1-95.9%; PFG vs. SDG: 69.7-70.9%; and for NT-proBNP: HFG vs. CG: 99.2-99.3%; SDG vs. CG: 99.6-99.7%; PFG vs. CG: 98.3-98.5%; PFG vs. SDG: 63.3-63.6%. For a cut-off of 32 pg/ml, BNP has 91.7% sens, 93.7% spec, 75.5% PPV and 98.3% NPV. A NT-proBNP cut-off of 126 pg/ml has 96.3% sens, 98.8% spec, 94.3% PPV and 99.3% NPV. CONCLUSIONS: Both peptides had an excellent ability to distinguish HF from non-HF subjects. NT-proBNP was more sensitive and specific. Nevertheless, neither peptide could differentiate between the SDG and the PFG by itself. NT-proBNP is a simple, highly effective diagnostic test for HF. A favorable impact on management and costs is expected from implementation of this diagnostic test in clinical practice. SN - 0870-2551 UR - https://www.unboundmedicine.com/medline/citation/15478324/Comparative_value_of_BNP_and_NT_proBNP_in_diagnosis_of_heart_failure_ L2 - https://medlineplus.gov/heartfailure.html DB - PRIME DP - Unbound Medicine ER -