Natriuretic peptides for the detection of diastolic dysfunction and heart failure with preserved ejection fraction—a systematic review and meta-analysis

Abstract

Background An overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking. Methods We performed a systematic literature search in PubMed and Embase.com (May 13, 2019). Studies were included when they (1) reported diagnostic performance measures, (2) are for the detection of DD or HFpEF in a non-acute setting, (3) are compared with a control group without DD or HFpEF or with patients with heart failure with reduced ejection fraction, (4) are in a cross-sectional design. Two investigators independently assessed risk of bias of the included studies according to the QUADAS-2 checklist. Results were meta-analysed when three or more studies reported a similar diagnostic measure. Results From 11,728 titles/abstracts, we included 51 studies. The meta-analysis indicated a reasonable diagnostic performance for both NPs for the detection of DD and HFpEF based on AUC values of approximately 0.80 (0.73–0.87; I2 = 86%). For both NPs, sensitivity was lower than specificity for the detection of DD and HFpEF: approximately 65% (51–85%; I2 = 95%) versus 80% (70–90%; I2 = 97%), respectively. Both NPs have adequate ability to rule out DD: negative predictive value of approximately 85% (78–93%; I2 = 95%). The ability of both NPs to prove DD is lower: positive predictive value of approximately 60% (30–90%; I2 = 99%). Conclusion The diagnostic performance of NPs for the detection of DD and HFpEF is reasonable. However, they may be used to rule out DD or HFpEF, and not for the diagnosis of DD or HFpEF.

Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

“… 23 , 24 , 25 In a recent systematic review, the low sensitivity of NT‐proBNP was again confirmed. 26 Nevertheless, some clinicians still use the low NT‐proBNP as an absolute rule‐out method.…”

Microvascular Dysfunction in Skeletal Muscle Precedes Myocardial Vascular Changes in Diabetic Cardiomyopathy: Sex-Dependent Differences

“…Echocardiography was performed on anesthetized rats with no stress testing incorporated. Cardiac blood panels did not include any markers for inflammation or brain type natriuretic peptide (BNP), although new studies are suggesting that BNP should not be considered a gold standard marker for diagnosing HFpEF ( 31 , 32 ). The number of animals for histological analysis could be higher; however, with ANOVA analysis, reporting of significance is conservative, and one can be confident of any metric reported to be different.…”

Biomarkers in Heart Failure with Preserved Ejection Fraction

“…A recent meta-analysis of 51 studies found that NPs have reasonable diagnostic performance in the detection of HFpEF in a nonacute setting (area under the receiver operating characteristics curve 0.80; 95% CI [0.73-0.87]; I 2 =86%) and are also a useful tool for ruling out diastolic dysfunction. 7 Interestingly, lower levels of NT-proBNP are found in patients with HFpEF in comparison with those with HF with reduced ejection fraction (HFrEF), 8,9 possibly because of the association of NPs with end-diastolic wall stress that appears to be lower in HFpEF. 10 Obokata et al attributed the lower NPs in HFpEF to lower wall stress due to pericardial restraint, which might be a dominant mechanism in some HfpEF patients.…”