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Clinical Chemistry 0: clinchem.2006.075713v1, 2007; 10.1373/clinchem.2006.075713
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Received on July 3, 2006
Accepted on February 13, 2007

Review

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

Aldo Clerico 1*, Marianna Fontana 2, Luc Zyw 2, Claudio Passino 1, Michele Emdin 2

1 Laboratory of Cardiovascular Endocrinology and Department of Cardiovascular Medicine, Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy, and Scuola Superiore S. Anna, Pisa, Italy
2 Laboratory of Cardiovascular Endocrinology and Department of Cardiovascular Medicine, Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy

* To whom correspondence should be addressed. E-mail: clerico{at}ifc.cnr.it.

Background: We used evidence-based laboratory medicine principles to compare the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) assays for the diagnosis of heart failure

Methods: In May 2006, we performed a computerized literature search of the online National Library of Medicine to select studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays. The comparison took into account the area under the curve and diagnostic odds ratio (DOR) derived from ROC analysis of original studies.

Results: Both BNP and NT-proBNP assays were found to be clinically useful for the diagnosis of heart failure. Metaanalysis of these data was difficult because of the heterogeneity of data regarding patient population, diagnostic criteria, end-points, and immunoassay methods for both BNP and NT-proBNP. Separate metaanalyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic DOR for BNP [8.44, 95% confidence interval (CI) 4.66-15.30] was not significantly different from that of NT-proBNP (23.36, 95% CI 9.38-58.19). In patients with acute heart failure, the mean DOR for BNP (16.46, 95% CI 10.65-25.43) was not significantly different from that of NT-proBNP (18.61, 95% CI 12.99-26.65).

Conclusion: Our results indicate that both BNP and NT-proBNP assays have a high degree of diagnostic accuracy and clinical relevance for both acute and chronic heart failure.


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