© 2006 European Society of Cardiology
Accuracy of B-type natriuretic peptide levels in the diagnosis of left ventricular dysfunction and heart failure: A systematic review
a Servei de Medicina Intensiva, Hospital General Universitari d'Elx. Elx Spain
b Departament d'Infermeria Comunitaria, Medicina Preventiva i Salut Pública i Història de la Ciència, Universitat d'Alacant Sant Vicent del Raspeig, Spain
c Unidad de Bioestadística Clínica. Hospital Ramón y Cajal, Node of R_MBE research network (G03/90) Madrid, Spain
d Departamento de Matemática Aplicada (Biomatemática), Universidad Complutense. Madrid, Spain
* Corresponding author. Hospital General Universitari d'Elx. Servei de Medicina Intensiva, Camí Vell de l'Almàssera 11, 03203 Elx, Spain. Tel.: +34 96 667 9511; fax: +34 96 667 9108. E-mail address: jlatour{at}ua.es
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Abstract |
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Objectives: To evaluate the accuracy of B-type natriuretic peptide levels (BNP) in the diagnosis of heart failure and left ventricular dysfunction.
Data sources: Electronic search in Medline, Embase, Cochrane Library and Medion database, and hand search of reference lists.
Review methods: We have included published studies on the accuracy of BNP which had both sufficient information to construct the 2x2 diagnostic cross table and an appropriate spectrum of patients.
Results: Fifty five studies (16,730 patients) were analyzed. The main determinants of diagnostic accuracy were the reference standard analyzed (clinical heart failure versus left ventricular dysfunction), and the methodological quality of the study. BNP levels were highly accurate for the diagnosis of clinical heart failure (diagnostic OR=41; 95% CI 23–74). The negative likelihood ratios were homogeneous, and useful for excluding the existence of heart failure (pooled negative likelihood ratio=0.11; 95% CI 0.08–0.16). The studies focused on the identification of left ventricular dysfunction were heterogeneous, with indications of publication bias, and showed less overall diagnostic accuracy than studies focused on heart failure.
Conclusions: BNP levels are useful for ruling out heart failure. The accuracy of BNP for identifying patients with systolic dysfunction is more limited.
Key Words: Heart failure • Natriuretic peptides • Sensitivity and specificity • ROC curve • Systematic review • Meta-analysis
Received March 28, 2005; Revised June 15, 2005; Accepted October 3, 2005
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