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European Journal of Heart Failure 2007 9(6-7):651-659; doi:10.1016/j.ejheart.2007.01.010
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© 2007 European Society of Cardiology

Comparison of B-type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary disease

Frans H. Ruttena,*, Maarten-Jan M. Cramerb, Nicolaas P.A. Zuithoffa, Jan-Willem J. Lammersb, Wim Verweijc, Diederick E. Grobbeea and Arno W. Hoesa

a Utrecht Heart Failure Organisation (UHFO), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
b Utrecht Heart Failure Organisation (UHFO), Heart Lung Center Utrecht, Department of Cardiology, University Medical Center Utrecht, The Netherlands
c Utrecht Heart Failure Organisation (UHFO), SALTRO, Department of Clinical Chemistry, PO Box 9300, 3506 GH Utrecht, The Netherlands

* Corresponding author. Utrecht Heart Failure Organisation (UHFO), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, Stratenum 6.131, 3508 AB Utrecht, The Netherlands. Tel: +31 30 2538193; fax: +31 30 2539028. E-mail address: F.H.Rutten{at}umcutrecht.nl (F.H. Rutten). URL: http://www.juliuscenter.nl (F.H. Rutten).


  Abstract

Aims: To compare the ability of different B-type natriuretic peptide (BNP) assays to identify heart failure in stable elderly patients with a diagnosis of chronic obstructive pulmonary disease (COPD).

Methods: 200 patients aged ≥65 years with COPD according to their general practitioner and without known heart failure, underwent a diagnostic work-up. The final diagnosis of heart failure was established by a panel using the diagnostic principles of the European Society of Cardiology. All available diagnostic results, including echocardiography, but not BNP or NT-proBNP measurements, were used. The ability of different B-type natriuretic peptide assays to identify heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area).

Results: The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP, and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent "optimal" cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure.

Conclusions: All assays of B-type natriuretic peptide showed reasonable and comparable accuracy in recognising heart failure. At "optimal" cut-points, all assays performed better at excluding than detecting new cases of heart failure in this population.

Key Words: Heart failure • B-type natriuretic peptides • Diagnosis • Chronic obstructive pulmonary disease

Received April 15, 2006; Revised November 29, 2006; Accepted January 18, 2007


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