The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: Results of the UK natriuretic peptide study

Zaphiriou, Alex; Robb, Stephen; Murray‐Thomas, Tarita; Méndez, Gustavo; Fox, Kevin; McDonagh, Theresa A.; Hardman, S. M. C.; Dargie, Henry J.; Cowie, Martin R.

doi:10.1016/j.ejheart.2005.01.022

Cited by 282 publications

(224 citation statements)

References 18 publications

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“…Indeed, evidence cited in the guidelines on the diagnostic utility of NP derives from patients with predominantly systolic dysfunction 5, 6, 7, 8, 9. Studies on the diagnostic utility of NP in HFpEF patients are conflicting 10, 11, 12, 13.…”

Section: Introductionmentioning

confidence: 99%

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

et al. 2018

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BackgroundHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that presents clinicians with a diagnostic challenge. The use of natriuretic peptides to exclude a diagnosis of HFpEF has been proposed. We sought to compare HFpEF patients with N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level above and below the proposed cut‐off.MethodsStable patients (n = 30) with left ventricular (LV) ejection fraction ≥ 50% were eligible if they had a diagnosis of HF according to the European Society of Cardiology diagnostic criteria. Characteristics of patients with NT‐proBNP below (≤125 pg/mL) and above (>125 pg/mL) the diagnostic criterion were compared.ResultsThere were 19 (66%) women with median age 54 years. Half were African American (16, 53%), and most were obese. There were no significant differences in clinical characteristics or medication use between groups. LV end‐diastolic volume index was greater in high NT‐proBNP patients (P = 0.03). Left atrial volume index, E/e′ ratio, and E/e′ ratio at peak exercise were not significantly different between NT‐proBNP groups. Peak oxygen consumption (VO2), VO2 at ventilatory threshold, and ventilatory efficiency measures were impaired in all patients and were not significantly different between high and low NT‐proBNP patients.ConclusionsNT‐proBNP was below the proposed diagnostic cut‐off point of 125 pg/mL in half of this obese study cohort. Cardiac diastolic dysfunction and cardiorespiratory fitness were not significantly different between high and low NT‐proBNP patients. These data indicate that excluding the diagnosis of HFpEF based solely on NT‐proBNP levels should be discouraged.

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Section: Introductionmentioning

confidence: 99%

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

et al. 2018

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“…A chest X-ray is moderately specific (76%-83%) but insensitive (67%-68% [23,24]. Some authors, however, have recently stated that NT-proBNP appears superior to BNP for the evaluation of suspected acute HF with preserved LV ejection fraction (LVEF) [25].…”

Section: Role Of Bnp In Urgent Care and Emergency Departmentsmentioning

confidence: 99%

Role of B-type natriuretic peptide (BNP) in heart failure

Uddin¹,

Rashid

Chowdhury³

2016

International Journal on Disability and Human Development

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Introduction: Early clinical diagnosis of heart failure (HF) is challenging because the signs and symptoms are neither sensitive nor specific for diagnosis. B-type natriuretic peptide (BNP), a cardiac neurohormone is a useful biomarker for patients with HF. Objectives: The purpose of this review is to evaluate the role of BNP in HF as a diagnostic, prognostic, and therapeutic marker in both outpatient care and urgent care settings. Methodology: An extensive literature review was conducted for this study. Findings: Determination of BNP is particularly useful as a rule-out test for suspected cases of HF in patients with dyspnoea. HF is very unlikely in patients with levels of BNP < 100 pg/mL whereas BNP levels > 400 pg/mL strongly support the diagnosis of HF. Elevated level of BNP indicates a worse prognosis in patients with HF. Conclusion: Although, it is recommended in the diagnostic pathways of guidelines for HF, it is not well established to recommend measurement of BNP to titrate HF medications because of lack of enough evidence. It requires further in-depth research.

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“…In one study, the combination of clinical signs had only a 58% rate of sensitivity in detecting patients with elevated pulmonary capillary wedge pressure (PCWP) [22], whereas radiographic pulmonary congestion was absent in 53% of patients with a PCWP of 16 to 29 mmHg and in 39% of patients with a PCWP of 30 mmHg [23]. Thus, the low diagnostic sensitivity of clinical assessments is recognized; on the other hand, the role of biomarkers (such as B-type natriuretic peptide [BNP] and N-terminal pro B-type natriuretic peptide [NT-proBNP]) in improving the same is also acknowledged [24,25]. In highly specialized and well-resourced tertiary centers, diagnostic accuracy can accordingly be close to 90% as well [24].…”

Section: Diagnostic Challengesmentioning

confidence: 99%

Management of acute heart failure-Is there a paradigm shift around the corner?

Pater

Severin²

2013

WJCD

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It has become increasingly apparent that the looming epidemic of heart failure calls for systematic treatment approaches tailored to the needs of individual patient phenotypes. Although chronic heart failure (CHF) therapies are continuously evolving based on the increasing understanding of the involved etiology, acute heart failure (AHF) therapies are still based on hemodynamic improvements and symptom alleviation. Guidelines on AHF management have highlighted that the currently administered AHF therapies lack evidence and have raised concerns on the safety and efficacy of some of the hitherto accepted treatment modalities. Additionally, the high mortality and morbidity rates associated with the current AHF therapies also add to the imperative need to re-visit AHF management. The last decade has witnessed a paradigm shift in the way we define and diagnose AHF. Apart from it being recognized as a distinct clinical entity, research has also led to new data on the pathophysiological changes associated with AHF. These developments along with the limited short-and long-term effects of currently used therapies may herald a paradigm shift in the way we plan and deliver management strategies to treat the pathological progression of heart failure.

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The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: Results of the UK natriuretic peptide study

Cited by 282 publications

References 18 publications

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

Role of B-type natriuretic peptide (BNP) in heart failure

Management of acute heart failure-Is there a paradigm shift around the corner?

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