• Andrew Worster, Cynthia M Balion, Stephen A Hill, Pasqualina Santaguida, Afisi Ismaila, Robert McKelvie, Sonja M Reichert, Matthew J McQueen, Lynda Booker, and Parminder S Raina.
• Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Clin. Biochem. 2008 Mar 1; 41 (4-5): 250-9.

ObjectiveWe sought to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP measurements in patients presenting to acute care settings with dyspnea, a common presenting symptom of heart failure.Design And MethodsWe conducted a systematic review of the literature. For all included studies, we applied the QUADAS 14-question quality assessment tool for systematic reviews of diagnostic accuracy and abstracted the data for every published cut point.ResultsWe screened 4338 studies and included nine in the meta-analysis. All 9 studies scored positively on at least 50% of the QUADAS questions. The pooled estimates of sensitivity and specificity were the same for the BNP studies (0.97 (95% CI: 0.96, 0.98) and 0.70 (95% CI: 0.56, 0.85)) as for the NT-proBNP studies (0.95 (95% CI: 0.90, 1.01) and 0.72 (95% CI: 0.53, 0.90)). Tests for heterogeneity were significant in both subgroups: BNP (I(2)=97.9%, p<0.001) and NT-proBNP (I(2)=87.5%, p<0.001). Similar overall results were found for the likelihood and diagnostic odds ratios.ConclusionsBNP and NT-proBNP have very similar diagnostic performance characteristics and can be used to rule out heart failure as a cause of dyspnea in the acute clinical setting. However, there is no easily identifiable optimum cut point value for each peptide.

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