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

Abstract Study aim The current study compares the diagnostic accuracy of BNP and NT-proBNP assays for the diagnosis of heart failure, according to evidence based laboratory medicine (EBLM) principles. Methods In May 2006, studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays were selected by means of a computerized literature search performed on National Library of Medicine. The comparison took into account the area under the curve (AUC) 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. A meta-analysis of these data was made difficult by the heterogeneity of data, regarding patient population, diagnostic criteria, end-points and immunoassay methods for both BNP and NT-proBNP. Separate meta-analyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic odds ratio (DOR) for BNP assay (DOR 8.44, 95% CI 4.66 – 15.30) was not significantly different from NT-proBNP one (23.36, 95% CI 9.38 – 58.19). In patients with acute heart failure, the mean DOR for BNP assay was 16.46 (95% CI 10.65 – 25.43) and for NT-proBNP assay 18.61 (95% CI 12.99 – 26.65), without a significant difference. Conclusion Our results indicate that both BNP and NT-proBNP assays have a high degree of diagnostic accuracy and clinical relevance in both acute and chronic heart failure.