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Diagnostic concordance between NT-proBNP and BNP for suspected heart failure

Christopher W Farnsworth1, Adam L Bailey1, Alan S Jaffe2

  • 1Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, United States.

Clinical Biochemistry
|August 17, 2018
PubMed

Insights

Diagnostic concordance between B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for heart failure (HF) is relatively low, especially in patients with chronic kidney disease. Current cutoffs require re-evaluation for accurate HF diagnosis.

Area of Science:

  • Cardiology
  • Clinical Diagnostics
  • Biomarker Research

Background:

  • Clinical guidelines consider B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) comparable for diagnosing and monitoring heart failure (HF).
  • Limited large-scale studies have directly assessed the diagnostic concordance between BNP and NT-proBNP.
  • Accurate HF diagnosis relies on reliable biomarker interpretation.

Purpose of the Study:

  • To evaluate the diagnostic concordance between BNP and NT-proBNP for ruling in and ruling out heart failure (HF).
  • To assess the correlation between BNP and NT-proBNP levels across different patient populations.
  • To investigate the impact of renal function on the concordance of these natriuretic peptides.

Main Methods:

  • Simultaneous testing of BNP and NT-proBNP on 2729 patient samples.
  • Utilized recommended cutoffs for BNP and NT-proBNP to assess diagnostic concordance and correlation.
  • Analyzed concordance based on hospital setting (ED vs. non-ED) and estimated glomerular filtration rate (eGFR).

Main Results:

  • Concordance between BNP and NT-proBNP was moderate (weighted kappa 0.695 in ED, 0.642 in non-ED).
  • Lower concordance observed in patients with eGFR <60 mL/min/1.73m² compared to those with eGFR >60 mL/min/1.73m².
  • Significant differences in NT-proBNP to BNP ratios were noted in patients with impaired renal function; temporal measurements showed discordant trends in 19.7% of cases.

Conclusions:

  • Current diagnostic cutoffs for BNP and NT-proBNP demonstrate relatively low concordance and correlation for HF diagnosis.
  • Diagnostic performance is particularly compromised in patients with chronic kidney disease.
  • Re-evaluation of established cutoffs is warranted to improve diagnostic accuracy for heart failure.
Abstract

Keywords:
ConcordanceCutpointsHeart failureNatriuretic peptides

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