Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2006 Jan;56(522):48-56.

Assessing the diagnostic test accuracy of natriuretic peptides and ECG in the diagnosis of left ventricular systolic dysfunction: a systematic review and meta-analysis

Clare Davenport  1 , Elaine Yee Lan Cheng, Yip Tung Tony Kwok, Annie Hiu On Lai, Taka Wakabayashi, Chris Hyde, Martin Connock
Affiliations
Meta-Analysis

Assessing the diagnostic test accuracy of natriuretic peptides and ECG in the diagnosis of left ventricular systolic dysfunction: a systematic review and meta-analysis

Clare Davenport et al. Br J Gen Pract. 2006 Jan.

Abstract

Background: In 2003 the National Institute of Clinical Excellence published guidelines recommending the use of brain natriuretic peptide (BNP) and the electrocardiogram (ECG) as part of the diagnostic work up of individuals with heart failure. However, the guideline did not address whether one test was superior to the other or whether performing both tests was superior to performing single tests.

Aim: To investigate the relative test accuracy of the ECG, BNP, N terminal-pro brain natriuretic peptide (NT-proBNP) and combinations of two or more tests in the diagnosis of left ventricular systolic dysfunction (LVSD) in the primary care setting.

Design of study: Cohort studies making within-subject comparisons of intervention diagnostic test(s) with reference standard results.

Method: Standard systematic review methodology was followed.

Results: Thirty-two primary studies met the review inclusion criteria. Studies were of variable quality and highly clinically heterogeneous, therefore restricting the use of meta-analysis. Within these limitations BNP, NT-proBNP and the ECG all had similar test sensitivity (>80% in the majority of studies). Specificity of the three tests was not as good. Three studies directly comparing BNP and the ECG found no difference in sensitivity and limited support for improved specificity of BNP. Two studies found no difference in sensitivity and limited evidence for an improvement in specificity for the combination of the ECG and BNP compared to single tests.

Conclusion: On the basis of existing evidence, the ECG, BNP and NT-proBNP are useful in excluding a diagnosis of LVSD (good sensitivity). However, use of abnormal test results to select individuals for echocardiography may overwhelm services. There is currently no evidence to justify the use of one test over another or the use of tests in combination. The additional cost of BNP is not self-evidently justified by improved test accuracy. Further research is needed to directly compare the diagnostic performance of these tests in homogeneous, representative primary care populations.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Summary of the study inclusion and exclusion process.
See this image and copyright information in PMC

Comment in

References

    1. Mair FS, Crowley TS, Bundred P. Prevalence, aetiology and management of heart failure in general practice. Br J Gen Pract. 1996;46:77–79. - PMC - PubMed
    1. Parameshwar J, Shackell MM, Richardson A, et al. Prevalence of heart failure in three general practices in north west London. Br J Gen Pract. 1992;42:287–289. - PMC - PubMed
    1. Wheeldon NM, MacDonald TM, Flucker CJ, et al. Echocardiography in chronic heart failure in the community. Q J Med. 1993;86(1):17–23. - PubMed
    1. Lamberts H, Brouwer HJ, Mohrs J. Reason for encounter — episode- and process-oriented standard output from the transition project. Amsterdam: Department of General Practice; 1990.
    1. Ambrosio GB, Riva L, Casiglia E. Prevalence of congestive heart failure (CHF) in elderly. A survey from a population of Veneto region. Acta Cardiologica. 1994;49:324–325.

Substances