PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
 
Br J Gen Pract. May 1, 2006; 56(526): 327–333.
PMCID: PMC1837840
The diagnostic accuracy and utility of a B-type natriuretic peptide test in a community population of patients with suspected heart failure
Ahmet Fuat, FRCGP, DRCOG, DFFP, PG Dip (Cardiology), GP
Department of Medicine, Darlington Memorial Hospital; Centre for Integrated Health Care Research. University of Durham; Darlington Primary Care Trust
Jeremy J Murphy, FRCGP, Consultant Cardiologist
Department of Medicine, Darlington Memorial Hospital
A Pali S Hungin, OBE, MD, FRCGP, FRSA, Dean of Medicine, Head of School Health
Centre for Integrated Health Care Research; University of Durham
Jane Curry, Principle Cardiac Clinical Physiologist
Department of Medicine, Darlington Memorial Hospital
Ali A Mehrzad, MD, FRCP, Consultant Physician
Department of Medicine, Bishop Auckland General Hospital
Andrew Hetherington, MRCP, MRCGP, DRCOG, GP and Hospital Practitioner in Heart Failure
Department of Medicine, Bishop Auckland General Hospital; Durham Dales Primary Care Trust, Bishop Auckland
Jennifer I Johnston, BA, FRCPath, Consultant Biochemist and W Stuart A Smellie, MA, DM FRCP, FRCPath, Consultant Chemical Pathologist
Department of Biochemistry, County Durham and Darlington Acute Hospitals NHS Trust
Victoria Duffy, RN, DipN, BSc, Specialist Nurse Practitioner in Heart Failure
Darlington Primary Care Trust
Patricia Cawley, RN, RM, BSc, MSc, Heart Failure Nurse
The Dales Primary Care Trust, Bishop Auckland
Address for correspondence Dr Ahmet Fuat, 35 Abbey Road, Darlington, County Durham DL3 8SQ. E-mail: ahmet/at/fuat.freeserve.co.uk
Received February 23, 2005; Revised May 31, 2005; Accepted January 25, 2006.
Abstract
Background
National guidelines suggest the use of natriuretic peptides in suspected heart failure but there have been no studies comparing assays in primary care.
Aim
To test and compare the diagnostic accuracy and utility of B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide (NT proBNP) in diagnosing heart failure due to left ventricular systolic dysfunction in patients with suspected heart failure referred by GPs to one-stop diagnostic clinics.
Design of study
Community cohort, prospective, diagnostic accuracy study.
Setting
One-stop diagnostic clinics in Darlington Memorial and Bishop Auckland General Hospitals and general practices in South Durham.
Subjects
Two hundred and ninety-seven consecutive patients with symptoms and signs suggestive of heart failure referred from general practice.
Method
The study measured sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under receiver operating characteristic curve for BNP (near patient assay) and NT proBNP (laboratory assay) in diagnosis of heart failure due to left ventricular systolic dysfunction. The NPV of both assays was determined as a potential method of reducing the number of referrals for echocardiography.
Results
One hundred and fourteen of the 297 patients had left ventricular systolic dysfunction (38%). At the manufacturer's recommended cut-off of 100 pg/ml BNP gave a NPV of 82%. BNP performed better at a cut-off of 40 pg/ml with a NPV of 88%. At a cut-off of 150 pg/ml, NT proBNP gave a NPV of 92%. Using cut-offs of 40 pg/ml and 150 pg/ml for BNP and NT pro-BNP, respectively, could have prevented 24% and 25% of referrals to the clinic, respectively.
Conclusions
In this setting, NT pro-BNP performed marginally better than BNP, and would be easier to use practically in primary care. A satisfactory cut-off has been identified, which needs validating in general practice. NT pro-BNP could be used to select referrals to a heart failure clinic or for echocardiography. This process needs testing in real-life general practice.
Keywords: diagnosis, heart failure, natriuretic peptides
Articles from The British Journal of General Practice are provided here courtesy of
Royal College of General Practitioners