Sheikh Mahboobeh, Ostadrahimi Pouya, Salarzaei Morteza, Parooie Fateme
Department of Cardiology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran.
Cardiol Ther. 2021 Dec;10(2):501-514. doi: 10.1007/s40119-021-00230-w. Epub 2021 Jul 2.
Serum brain-type natriuretic peptide (BNP) levels may be involved in detecting the breakdown of defense mechanisms in pregnant women. BNP and N-terminal pro-BNP (NT-proBNP) levels can be used in emergency settings as a biomarker to rule out or confirm cardiac complications. The present study was conducted as an attempt to evaluate the performance of BNP and NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant and recently-delivered women.
This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To extract the data, articles meeting the inclusion criteria were directly reviewed by two of the authors. Disputes were resolved through discussion with all authors before data mining. In cases of unresolved disagreement, a third reviewer was consulted to achieve consensus. A quantitative analysis of the total bias of publications was performed using Stata software version 14.0, using funnel plots and Deek's test.
Overall, 13 unique studies were included in this review. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women when BNP level was ≤ 100 ng/L, were determined to be 95, 62, 71 and 91%, respectively. The corresponding measures when the BNP levels were 100-500 ng/L were calculated to be 98, 92, 97 and 92%, respectively. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women using NT-proBNP were 78, 74, 20.5 and 97%, respectively.
Our results suggest that both BNP and NT-proBNP levels can be used as diagnostic tools among pregnant and newly-delivered women to diagnose cardiac complications, including heart failure and pre-eclampsia. While BNP showed a relatively better diagnostic accuracy compared to NT-proBNP, it must be noted that the number of studies evaluating NT-proBNP included in this meta-analysis was low and the studies were inconsistent in terms of cutoff value. Further studies are required to confirm the prospective use of BNP and NT-pro BNP in assessing common symptoms that indicate cardiac complications during labor. Moreover, the clinical use of the NT-proBNP test in this field requires further study.
血清脑钠肽（BNP）水平可能参与检测孕妇防御机制的破坏情况。BNP和N末端前脑钠肽（NT-proBNP）水平可在紧急情况下用作生物标志物，以排除或确认心脏并发症。本研究旨在评估BNP和NT-proBNP作为诊断工具对孕妇及近期分娩女性心脏并发症（包括心力衰竭和子痫前期）的诊断效能。
本荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。为提取数据，符合纳入标准的文章由两位作者直接审阅。在数据挖掘之前，通过与所有作者讨论解决争议。对于未解决的分歧，咨询第三位审阅者以达成共识。使用Stata软件14.0版，通过漏斗图和Deek检验对出版物的总偏倚进行定量分析。
总体而言，本综述纳入了13项独特的研究。当BNP水平≤100 ng/L时，诊断孕妇心脏并发症的合并敏感性、特异性、阳性预测值和阴性预测值分别确定为95%、62%、71%和91%。当BNP水平为100 - 500 ng/L时，相应的指标分别计算为98%、92%、97%和92%。使用NT-proBNP诊断孕妇心脏并发症的合并敏感性、特异性、阳性预测值和阴性预测值分别为78%、74%、20.5%和97%。
我们的结果表明，BNP和NT-proBNP水平均可作为诊断工具，用于孕妇及刚分娩女性诊断包括心力衰竭和子痫前期在内的心脏并发症。虽然与NT-proBNP相比，BNP显示出相对更好的诊断准确性，但必须注意的是，本荟萃分析中评估NT-proBNP的研究数量较少，且研究在临界值方面不一致。需要进一步研究以确认BNP和NT-proBNP在评估分娩期间提示心脏并发症的常见症状方面的前瞻性应用。此外，NT-proBNP检测在该领域的临床应用需要进一步研究。
