Clinical Chemistry
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Clinical Chemistry 53: 1719-1720, 2007; 10.1373/clinchem.2007.091876
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(Clinical Chemistry. 2007;53:1719-1720.)
© 2007 American Association for Clinical Chemistry, Inc.

Letters to the Editor

Comparison of the Diagnostic Accuracy of BNP and NT-proBNP in Acute and Chronic Heart Failure

Christian Mueller

Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland, Fax 0041-61-2655353, E-mail chmueller{at}uhbs.ch.


To the Editor:

I read with great interest the paper by Clerico et al. (1), which described a comparable diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) in patients with heart failure. The authors are to be congratulated for addressing this important issue.

There are two details that concern me that might benefit from additional explanations from the authors. First, the paper cites an important study that compared both markers in elderly patients only (2). This patient subset is of major importance because diagnostic uncertainty seems to be highest in elderly patients (3). BNP was found to have significantly higher diagnostic accuracy than NT-proBNP (area under the curve 0.85 vs 0.80) in elderly patients. Unfortunately, in Table 2 and in Fig. 3, these data seem to be incorrectly displayed, indicating the opposite result (superiority of NT-proBNP). The authors may wish to correct this presentation of their data and recalculate their metaanalysis accordingly. Second, the expression "chronic heart failure" does not seem appropriate for the second part of the analysis, because the studies summarized in Table 1 and Fig. 2 tested both peptides in the detection of left ventricular systolic and/or diastolic dysfunction. Please note that chronic heart failure must not be used interchangeably as a term for these conditions.


Acknowledgments

Grant/funding support: None declared.

Financial disclosures: I have received research support from Biosite, Brahms, Abbott, and Roche, and speaker’s honoraria from Abbott, Bayer, Biosite, Brahms, Dade Behring, and Roche.


References

  1. Clerico A, Fontana M, Zyw L, Passino C, Emdin M. Comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure: a systematic review. Clin Chem 2007;53:813-822.[Abstract/Free Full Text]
  2. Ray P, Arthaud M, Birolleau S, Isnard R, Lefort Y, Boddaert J, et al. Comparison of brain natriuretic peptide and probrain natriuretic peptide in the diagnosis of cardiogenic pulmonary edema in patients aged 65 and older. J Am Geriatr Soc 2005;53:643-648.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  3. Mueller C, Laule-Kilian K, Frana B, Rodriguez D, Rudez J, Scholer A, et al. The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea. J Intern Med 2005;258:77-85.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]




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