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Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath

^* Department of Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand

View larger version (14K): [in a new window]   Figure 1 Brain natriuretic peptide (BNP) and N-terminal BNP (N-BNP) values by five different assays in 135 subjects without heart failure (open bars) and 70 patients with heart failure (striped bars). Values were significantly higher by all assays for those with heart failure (p < 0.001 for all). Biosite = Biosite point-of-care BNP assay; Clinical = local clinical BNP assay; Research = local research BNP assay; Roche = Roche N-BNP assay; Local = local N-BNP assay. Bars indicate median value and interquartile range, lines represent 10th and 90th percentile values, dots represent outlying values.

View larger version (15K): [in a new window]   Figure 2 Brain natriuretic peptide (BNP) and N-terminal BNP (N-BNP) results from five different assays in 112 patients with no heart failure (open bars), 23 patients with no heart failure but significant left ventricular systolic dysfunction or left-sided valvular disease (striped bars), and 70 patients with congestive heart failure (dotted bars). By all assays, results from the group with significant left ventricular dysfunction or left-sided valvular disease and no heart failure were significantly higher than those without heart failure and significantly less than those with heart failure (p < 0.01 for all comparisons). Biosite = Biosite point-of-care BNP assay; Clinical = local clinical BNP assay; Research = local research BNP assay; Roche = Roche N-BNP assay; Local = local N-BNP assay. Bars indicate median value and interquartile range, lines represent 10th and 90th percentile values, dots represent outlying values.

View larger version (20K): [in a new window]   Figure 3 Correlation between the results of the Roche N-terminal brain natriuretic peptide (N-BNP) assay and the Biosite brain natriuretic peptide (BNP) assay (top) and Roche N-BNP assay and Local N-BNP assay (bottom). The assay results are log transformed. Biosite BNP = Biosite point-of-care BNP assay; Roche N-BNP = Roche N-BNP assay; Local N-BNP = local N-BNP assay.

View larger version (28K): [in a new window]   Figure 4 Receiver-operating characteristic curves for the five assays for the diagnosis of heart failure. A range of cut-off values for the commercially available Biosite brain natriuretic peptide (BNP) and Roche N-terminal brain natriuretic peptide (N-BNP) assays are given at the bottom of the figure; the highlighted row represents the optimal value for specificity and sensitivity. ACC = overall accuracy of the test; AUC = area under the receiver-operating characteristic curve; NPV = negative predictive value; PPV = positive predictive value; Spec = specificity; Sens = sensitivity. The arrows indicate the optimum value for cut-off for specificity and sensitivity, defined as the point geometrically closest to perfect sensitivity and specificity. Overall accuracy of the test is defined as the percentage of patients correctly classified as having heart failure or not. Clinical BNP = local clinical BNP assay; Biosite BNP = Biosite point-of-care BNP assay; Research BNP = local research BNP assay; Roche N-BNP = Roche N-BNP assay; Local N-BNP = local N-BNP assay.