The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting.
The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting.
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DOI：
10.1136/bmj.h910
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发表时间：
2015-03-04
期刊：
影响因子：
--
通讯作者：
NICE Guideline Development Group for Acute Heart Failure
中科院分区：
文献类型：
--
作者：
Roberts E;Ludman AJ;Dworzynski K;Al-Mohammad A;Cowie MR;McMurray JJ;Mant J;NICE Guideline Development Group for Acute Heart Failure
目的使用2012年欧洲心脏病学会心力衰竭指南中推荐的阈值，确定并比较急性心力衰竭患者血清利钠肽水平（B型利钠肽、N末端脑钠肽前体（NTproBNP）和中段心钠肽前体（MRproANP））诊断急性心力衰竭的准确性。设计系统性综述和诊断性荟萃分析。数据来源Medline、Embase、科克伦对照试验中心注册库、科克伦系统性综述数据库、效应综述摘要数据库、NHS经济评价数据库和卫生技术评估，截至2014年1月28日，使用心力衰竭和利钠肽相关主题词和术语组合。选择研究的合格标准合格研究在急性护理环境中连续或随机选择的成人中，对照可接受的参考标准，评价了一种或多种利钠肽（B型利钠肽、NTproBNP或MRproANP）在诊断急性心力衰竭中的作用。如果研究没有提供足够的数据来提取或计算真阳性、假阳性、假阴性和真阴性，或报告与年龄无关的利钠肽阈值，则将其排除。没有英文版的研究也被排除在外。结果纳入了42份研究报告中描述的37个独特的研究队列，共有48项测试评价报告了15263个测试结果。在B型利钠肽100 ng/L和NTproBNP 300 ng/L的推荐阈值下限下，利钠肽的灵敏度为0.95（95%置信区间0.93 - 0.96）和0.99（0.97 - 1.00）和阴性预测值分别为0.94（0.90 - 0.96）和0.98（0.89 - 1.0）。在推荐阈值下限120 pmol/L时，MRproANP的灵敏度范围为0.95（范围0.90-0.98）至0.97（0.95-0.98），阴性预测值范围为0.90（0.80-0.96）至0.97（0.96-0.98）。在较高的阈值下，灵敏度逐渐下降，特异性在整个值范围内保持可变。血浆B型利钠肽与NTproBNP在诊断准确性上差异无统计学意义。结论在2012年欧洲心脏病学会心力衰竭指南推荐的排除阈值范围内，血浆B型利钠肽、NTproBNP和MRproANP对急性心力衰竭有很好的排除能力。特异性是可变的，因此需要成像来确认心力衰竭的诊断。血浆B型利钠肽与NTproBNP的诊断准确性无统计学差异。在疑似急性心力衰竭患者的调查中引入利钠肽测量有可能快速准确地排除诊断。
Objectives To determine and compare the diagnostic accuracy of serum natriuretic peptide levels (B type natriuretic peptide, N terminal probrain natriuretic peptide (NTproBNP), and mid-regional proatrial natriuretic peptide (MRproANP)) in people presenting with acute heart failure to acute care settings using thresholds recommended in the 2012 European Society of Cardiology guidelines for heart failure. Design Systematic review and diagnostic meta-analysis. Data sources Medline, Embase, Cochrane central register of controlled trials, Cochrane database of systematic reviews, database of abstracts of reviews of effects, NHS economic evaluation database, and Health Technology Assessment up to 28 January 2014, using combinations of subject headings and terms relating to heart failure and natriuretic peptides. Eligibility criteria for selecting studies Eligible studies evaluated one or more natriuretic peptides (B type natriuretic peptide, NTproBNP, or MRproANP) in the diagnosis of acute heart failure against an acceptable reference standard in consecutive or randomly selected adults in an acute care setting. Studies were excluded if they did not present sufficient data to extract or calculate true positives, false positives, false negatives, and true negatives, or report age independent natriuretic peptide thresholds. Studies not available in English were also excluded. Results 37 unique study cohorts described in 42 study reports were included, with a total of 48 test evaluations reporting 15 263 test results. At the lower recommended thresholds of 100 ng/L for B type natriuretic peptide and 300 ng/L for NTproBNP, the natriuretic peptides have sensitivities of 0.95 (95% confidence interval 0.93 to 0.96) and 0.99 (0.97 to 1.00) and negative predictive values of 0.94 (0.90 to 0.96) and 0.98 (0.89 to 1.0), respectively, for a diagnosis of acute heart failure. At the lower recommended threshold of 120 pmol/L, MRproANP has a sensitivity ranging from 0.95 (range 0.90-0.98) to 0.97 (0.95-0.98) and a negative predictive value ranging from 0.90 (0.80-0.96) to 0.97 (0.96-0.98). At higher thresholds the sensitivity declined progressively and specificity remained variable across the range of values. There was no statistically significant difference in diagnostic accuracy between plasma B type natriuretic peptide and NTproBNP. Conclusions At the rule-out thresholds recommended in the 2012 European Society of Cardiology guidelines for heart failure, plasma B type natriuretic peptide, NTproBNP, and MRproANP have excellent ability to exclude acute heart failure. Specificity is variable, and so imaging to confirm a diagnosis of heart failure is required. There is no statistical difference between the diagnostic accuracy of plasma B type natriuretic peptide and NTproBNP. Introduction of natriuretic peptide measurement in the investigation of patients with suspected acute heart failure has the potential to allow rapid and accurate exclusion of the diagnosis.
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DOI：
10.1080/00365510701810605
发表时间：
2008-01-01
影响因子：
2.1
作者：
Gruson, Damien;Rousseau, Michel F.;Verschuren, Franck
通讯作者：
Verschuren, Franck
DOI：
10.1016/s0735-1097(03)00787-3
发表时间：
2003-08-20
影响因子：
24
作者：
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通讯作者：
Richards, AM
影响因子：
18.2
作者：
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通讯作者：
Picano, E.
影响因子：
1.9
作者：
Klemen, Petra;Golub, Mirjam;Grmec, Stefek
通讯作者：
Grmec, Stefek
影响因子：
2.8
作者：
Dokainish, H;Zoghbi, WA;Nagueh, SF
通讯作者：
Nagueh, SF