A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure

Doust, Jenny A., Glasziou, Paul P., Pietrzak, Eva and Dobson, Annette J. (2004) A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Archives of Internal Medicine, 164 18: 1978-1984. doi:10.1001/archinte.164.18.1978

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Author Doust, Jenny A.
Glasziou, Paul P.
Pietrzak, Eva
Dobson, Annette J.
Title A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure
Journal name Archives of Internal Medicine   Check publisher's open access policy
ISSN 0003-9926
Publication date 2004-10-11
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1001/archinte.164.18.1978
Open Access Status File (Publisher version)
Volume 164
Issue 18
Start page 1978
End page 1984
Total pages 7
Editor J. E. Dalen
Place of publication Chicago, IL, United States
Publisher American Medical Association
Collection year 2004
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
320305 Medical Biochemistry - Proteins and Peptides
320000 Medical and Health Sciences
Formatted abstract
Background: The diagnosis of heart failure is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Natriuretic peptides have been proposed as a possible test for assisting diagnosis. We assessed the diagnostic accuracy of brain natriuretic peptide (BNP), including a comparison with atrial natriuretic peptide (ANP).

Electronic searches were conducted of MEDLINE and EMBASE from January 1994 to December 2002 and handsearches of reference lists of included studies. We included studies that assessed the diagnostic accuracy of BNP against echocardiographic or clinical criteria or that compared the diagnostic accuracy of BNP with ANP. Two reviewers assessed studies for inclusion and quality and extracted the relevant data. A meta-analysis was performed by pooling the diagnostic odds ratios for studies that used a common reference standard.

Twenty studies were included. For the 8 studies (n = 4086) that measured BNP against the criterion of left ventricular ejection fraction of 40% or less (or equivalent), the pooled diagnostic odds ratio was 11.6 (95% confidence interval, 8.4-16.1). The pooled diagnostic odds ratio was greater, 30.9 (95% confidence interval, 27.0-35.4), in the 7 studies (n = 2374) that measured BNP against clinical criteria (generally a consensus view using all other clinical information). The diagnostic odds ratio was similar in studies conducted in general practice and in hospital settings. Three studies compared BNP with N-terminal–ANP, a precursor form of ANP, and pooling of the results of these studies showed BNP to be a more accurate marker of heart failure than NT-ANP.

Conclusions: Brain natriuretic peptide is an accurate marker of heart failure. Use of a cutoff value of 15 pmol/L achieves high sensitivity, and BNP values below this exclude heart failure in patients in whom disease is suspected. As the diagnostic odds ratio for BNP is greater when assessed against clinical criteria than against left ejection fraction alone, BNP may also be detecting patients with "diastolic" heart failure.
Keyword Medicine, General & Internal
Left-ventricular Dysfunction
Systolic Dysfunction
Diastolic Dysfunction
Emergency Diagnosis
Q-Index Code C1
Additional Notes This document is a journal review.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 187 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 238 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 03:59:48 EST