Accuracy of B-type natriuretic peptide levels in the diagnosis of left ventricular dysfunction and heart failure:: A systematic review

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 2 x 2 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. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.