Diagnostic accuracy of B type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure.
Journal: 2005/May - Heart
ISSN: 1468-201X
Abstract:
OBJECTIVE
To compare head to head the diagnostic accuracy of B type natriuretic peptide (BNP) and the amino terminal fragment of its precursor hormone (NT-proBNP) for congestive heart failure (CHF) in an emergency setting.
METHODS
251 consecutive patients presenting to the emergency department with dyspnoea as a chief complaint were prospectively studied. Patients with acute coronary syndromes were excluded. The diagnosis of CHF was based on the Framingham score for CHF plus echocardiographic evidence of systolic or diastolic dysfunction. Blood concentrations of BNP and NT-proBNP were measured by two commercially available assays (Abbott and Roche methods). The diagnostic accuracies of BNP and NT-proBNP were assessed by receiver operating characteristic curve analysis.
RESULTS
Areas under the curve for BNP and NT-proBNP in patients with dyspnoea caused by CHF (n = 137) and in patients with dyspnoea attributable to other reasons (n = 114) did not differ significantly (area under the curve 0.916 v 0.903, p = 0.277, statistical power 94%). Cut off concentrations with the highest diagnostic accuracy were 295 ng/l for BNP (sensitivity 80%, specificity 86%, diagnostic accuracy 83%) and 825 ng/l for NT-proBNP (sensitivity 87%, specificity 81%, diagnostic accuracy 84%). Evaluation of discordant false classifications at these cut off concentrations showed no advantage for either BNP nor NT-proBNP in the biochemical diagnosis of CHF (17 misclassifications by BNP and 14 by NT-proBNP, p = 0.720). In the population studied, age, sex, and renal function had no impact on the diagnostic utility of both tests when compared by logistic regression models.
CONCLUSIONS
BNP and NT-proBNP may be equally useful as an aid in the diagnosis of CHF in short of breath patients presenting to the emergency department.
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Discussion board
Heart 91(5): 606-612

Diagnostic accuracy of B type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure

Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
Department of Internal Medicine, Konventhospital Barmherzige Brueder
Institute for Applied System Sciences and Statistics, University of Linz
Correspondence to:
Dr Meinhard Haltmayer
Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Seilerstaette 2, A-4021 Linz, Austria; ta.znilbb@reyamtlah.drahniem
Correspondence to:
Dr Meinhard Haltmayer
Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Seilerstaette 2, A-4021 Linz, Austria; ta.znilbb@reyamtlah.drahniem
Accepted 2004 Jul 28.

Abstract

Objective: To compare head to head the diagnostic accuracy of B type natriuretic peptide (BNP) and the amino terminal fragment of its precursor hormone (NT-proBNP) for congestive heart failure (CHF) in an emergency setting.

Methods: 251 consecutive patients presenting to the emergency department with dyspnoea as a chief complaint were prospectively studied. Patients with acute coronary syndromes were excluded. The diagnosis of CHF was based on the Framingham score for CHF plus echocardiographic evidence of systolic or diastolic dysfunction. Blood concentrations of BNP and NT-proBNP were measured by two commercially available assays (Abbott and Roche methods). The diagnostic accuracies of BNP and NT-proBNP were assessed by receiver operating characteristic curve analysis.

Results: Areas under the curve for BNP and NT-proBNP in patients with dyspnoea caused by CHF (n  =  137) and in patients with dyspnoea attributable to other reasons (n  =  114) did not differ significantly (area under the curve 0.916 v 0.903, p  =  0.277, statistical power 94%). Cut off concentrations with the highest diagnostic accuracy were 295 ng/l for BNP (sensitivity 80%, specificity 86%, diagnostic accuracy 83%) and 825 ng/l for NT-proBNP (sensitivity 87%, specificity 81%, diagnostic accuracy 84%). Evaluation of discordant false classifications at these cut off concentrations showed no advantage for either BNP nor NT-proBNP in the biochemical diagnosis of CHF (17 misclassifications by BNP and 14 by NT-proBNP, p  =  0.720). In the population studied, age, sex, and renal function had no impact on the diagnostic utility of both tests when compared by logistic regression models.

Conclusions: BNP and NT-proBNP may be equally useful as an aid in the diagnosis of CHF in short of breath patients presenting to the emergency department.

Keywords: diagnosis, echocardiography, heart failure, natriuretic peptides
Abstract

B type natriuretic peptide (BNP) is a cardiac neurohormone that derives from the precursor pre-proBNP, containing 134 amino acids and including a signal peptide of 26 amino acids. proBNP, produced by cleavage of the signal peptide, is further split into BNP, which is considered to be the biologically active hormone, and an inactive amino terminal fragment, NT-proBNP.1 Blood measurements of BNP have been shown to be useful in differentiating dyspnoea caused by congestive heart failure (CHF) from dyspnoea related to other causes.2,3 More recently, the BNP (breathing not properly) study showed the usefulness of determining BNP in the emergency department in establishing or excluding CHF in patients with dyspnoea.4,5 The authors of the BNP study showed that the evaluation of dyspnoea was improved by the addition of BNP testing to clinical judgement in the emergency department.5 Another recent publication indicated that measurement of NT-proBNP may also be a diagnostic aid in the verification of CHF in patients with shortness of breath.6 However, potential advantages of either BNP or NT-proBNP for the diagnosis of CHF in an emergency setting are not established.

Thus, the present study was designed to compare head to head the diagnostic accuracy of BNP and NT-proBNP with respect to CHF in patients consulting our emergency department with shortness of breath as a chief complaint. Furthermore, we aimed at assessing appropriate cut off concentrations for this clinical setting by means of two currently developed commercially available assays for BNP and NT-proBNP.

Acknowledgments

This work was supported in part by a grant for scientific research from the Upper Austrian Government. We thank Abbott Diagnostics (Vienna, Austria) and Roche Diagnostics (Vienna, Austria) for providing reagents free of charge. Neither of these companies played a part in (1) the design of the study, (2) data collection, analysis, and interpretation, and (3) preparation of the manuscript.

Acknowledgments

Abbreviations

  • AUC, area under the curve

  • BNP, B type natriuretic peptide

  • BNP study, breathing not properly study

  • CHF, congestive heart failure

  • CV, coefficient of variance

  • eGFR, estimated glomerular filtration rate

  • LVEF, left ventricular ejection fraction

  • NCCLS, National Committee for Clinical Laboratory Standards

  • NT-proBNP, amino terminal fragment of proBNP

  • ROC, receiver operating characteristic

  • STARD, standards for reporting of diagnostic accuracy

Abbreviations

REFERENCES

REFERENCES

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