Comparative value of BNP and NT-proBNP in diagnosis of heart failure

Candida Fonseca, Pedro M Sarmento, Ana Minez, Elsa Gonçalves, Ricardo Covas, Ana Ramos Dias, Maria Julieta Esperança Pina, Fátima Ceia
Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology 2004, 23 (7-8): 979-91

UNLABELLED: Heart failure (HF) remains a major diagnostic challenge. Brain natriuretic peptide (BNP) and the N-terminal portion of proBNP (NT-proBNP) have emerged as excellent diagnostic biohumoral indicators in cardiac disease. It is not clear which of the two is superior as a diagnostic marker in HF.

OBJECTIVE: To compare the ability of BNP and NT-proBNP to distinguish subjects with HF from healthy volunteers, as well as to differentiate between HF with left ventricular (LV) systolic dysfunction (SD) and HF with preserved systolic function (PSF).

METHODS: We measured plasma BNP (Shionogi, Osaka) and NT-proBNP (ELECSYS) in 21 healthy individuals (control group [CG]), 11 men, 10 women, mean age 54.4 +/- 11.6 years, with normal ECG and chest X-ray, and in 86 HF patients (HFG), 48 men, 38 women, mean age 71 +/- 11 years, in NYHA II-IV, fulfilling the European Society of Cardiology guidelines: 60 had HF with SD (SDG), ejection fraction (EF) < 40%, and 26 had HF and PSF (PFG), EF > 40%, increased LV mass index and/or dilated left atrium. BNP and NT-proBNP mean and median values were compared and the correlation between the 2 peptides was established. For each peptide sensitivity (sens), specificity (spec) 93.7%, positive predictive value (PPV) 75.5% and negative predictive value (NPV) were calculated. Areas under the ROC curve (AUC) were determined for each group vs. CG and for SDG vs. PFG.

RESULTS: Levels of BNP and NT-proBNP were significantly higher in HF patients, particularly in the SDG, than in healthy subjects. There was reasonable agreement between BNP and NT-proBNP. For BNP, AUC were: HFG vs. CG: 97.7-98.0%; SDG vs. CG: 98.6-99.1%; PFG vs. CG: 95.1-95.9%; PFG vs. SDG: 69.7-70.9%; and for NT-proBNP: HFG vs. CG: 99.2-99.3%; SDG vs. CG: 99.6-99.7%; PFG vs. CG: 98.3-98.5%; PFG vs. SDG: 63.3-63.6%. For a cut-off of 32 pg/ml, BNP has 91.7% sens, 93.7% spec, 75.5% PPV and 98.3% NPV. A NT-proBNP cut-off of 126 pg/ml has 96.3% sens, 98.8% spec, 94.3% PPV and 99.3% NPV.

CONCLUSIONS: Both peptides had an excellent ability to distinguish HF from non-HF subjects. NT-proBNP was more sensitive and specific. Nevertheless, neither peptide could differentiate between the SDG and the PFG by itself. NT-proBNP is a simple, highly effective diagnostic test for HF. A favorable impact on management and costs is expected from implementation of this diagnostic test in clinical practice.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"