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Natriuretic Peptide testing in primary care.

Rehman SU, Januzzi JL - Curr Cardiol Rev (2008)

Bottom Line: The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully.Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics).Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Division of Cardiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA.

ABSTRACT
The incidence, as well as the morbidity and mortality associated with heart failure (HF) continue to rise despite advances in diagnostics and therapeutics. A recent advance in the diagnostic and therapeutic approach to HF is the use of natriuretic peptide (NP) testing, including both B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-proBNP). NPs may be elevated at an early stage among those with symptoms as well among those without. The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully. Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics). As well, unlike for acute HF, the cut off value for outpatient testing for BNP is 20-40 pg/mL and for NTproBNP it is 100-150 ng/L. In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values and their use may be cost effective. Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous. There are several ongoing trials looking at that prospect.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic (ROC) curves for the ability of NT-proBNP to diagnose systolic HF and LVEF ≤50%/≤45%/≤ 40%/≤ 35%, respectively. For the diagnosis of heart failure ≤40, NT-proBNP = 106.7 pmol/l had sensitivity/specificity 0.92/0.86, positive predictive value /negative predictive value 0.11/1.00 and AUC = 0.94 Groenning BA et al. [96].
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Figure 2: Receiver operating characteristic (ROC) curves for the ability of NT-proBNP to diagnose systolic HF and LVEF ≤50%/≤45%/≤ 40%/≤ 35%, respectively. For the diagnosis of heart failure ≤40, NT-proBNP = 106.7 pmol/l had sensitivity/specificity 0.92/0.86, positive predictive value /negative predictive value 0.11/1.00 and AUC = 0.94 Groenning BA et al. [96].

Mentions: In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values [94-100]. In patients with symptoms suggestive of HF, Cowie et al. [94] investigated the value of BNP and showed that a cut-off value of 22 pmol/L for BNP could rule out the diagnosis of HF with high NPV of 98%. Similarly, in a prospective, randomized controlled trial involving 305 patients with symptoms of dyspnea and/or peripheral edema, NT-proBNP measurement significantly improved the diagnostic accuracy by a general practitioner over and above clinical review by correctly ruling out heart failure [95]. In another study [96] (Fig. 2), NT-proBNP levels identified those with symptoms of heart failure and LVEF ≤40% among general population with a sensitivity of 92%, a specificity of 86%, negative predictive values of 100% and area under the curve of 0.94. Similarly in another study [97] both BNP and NT-proBNP had excellent negative predictive values for exclusion of HF in patients with clinical suspicion of HF; in this study, a BNP at a cut-off of 40 pg/ml had a NPV of 88%, and an NT-proBNP of 150 pg/ml gave a NPV of 92%.


Natriuretic Peptide testing in primary care.

Rehman SU, Januzzi JL - Curr Cardiol Rev (2008)

Receiver operating characteristic (ROC) curves for the ability of NT-proBNP to diagnose systolic HF and LVEF ≤50%/≤45%/≤ 40%/≤ 35%, respectively. For the diagnosis of heart failure ≤40, NT-proBNP = 106.7 pmol/l had sensitivity/specificity 0.92/0.86, positive predictive value /negative predictive value 0.11/1.00 and AUC = 0.94 Groenning BA et al. [96].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2801862&req=5

Figure 2: Receiver operating characteristic (ROC) curves for the ability of NT-proBNP to diagnose systolic HF and LVEF ≤50%/≤45%/≤ 40%/≤ 35%, respectively. For the diagnosis of heart failure ≤40, NT-proBNP = 106.7 pmol/l had sensitivity/specificity 0.92/0.86, positive predictive value /negative predictive value 0.11/1.00 and AUC = 0.94 Groenning BA et al. [96].
Mentions: In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values [94-100]. In patients with symptoms suggestive of HF, Cowie et al. [94] investigated the value of BNP and showed that a cut-off value of 22 pmol/L for BNP could rule out the diagnosis of HF with high NPV of 98%. Similarly, in a prospective, randomized controlled trial involving 305 patients with symptoms of dyspnea and/or peripheral edema, NT-proBNP measurement significantly improved the diagnostic accuracy by a general practitioner over and above clinical review by correctly ruling out heart failure [95]. In another study [96] (Fig. 2), NT-proBNP levels identified those with symptoms of heart failure and LVEF ≤40% among general population with a sensitivity of 92%, a specificity of 86%, negative predictive values of 100% and area under the curve of 0.94. Similarly in another study [97] both BNP and NT-proBNP had excellent negative predictive values for exclusion of HF in patients with clinical suspicion of HF; in this study, a BNP at a cut-off of 40 pg/ml had a NPV of 88%, and an NT-proBNP of 150 pg/ml gave a NPV of 92%.

Bottom Line: The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully.Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics).Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Division of Cardiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA.

ABSTRACT
The incidence, as well as the morbidity and mortality associated with heart failure (HF) continue to rise despite advances in diagnostics and therapeutics. A recent advance in the diagnostic and therapeutic approach to HF is the use of natriuretic peptide (NP) testing, including both B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-proBNP). NPs may be elevated at an early stage among those with symptoms as well among those without. The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully. Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics). As well, unlike for acute HF, the cut off value for outpatient testing for BNP is 20-40 pg/mL and for NTproBNP it is 100-150 ng/L. In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values and their use may be cost effective. Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous. There are several ongoing trials looking at that prospect.

No MeSH data available.


Related in: MedlinePlus