Karimi Mohammad Amin, Kazemi Ferezghi Zahra, Khademi Reza, Mazhari Seyed Amirhossein, Chichagi Fatemeh, Rasouli Asma, Alikhani Reyhaneh, Sani Anis, Akhavan Rezayat Shima, Shakouri Nima, Azimi Seyed Iraj, Jadidian Faezeh, Nikeghbali Golnaz, Edrisian Mahfam, Alizadeh Alaleh, Deravi Niloofar, Poudineh Mohadeseh, Asadi Anar Mahsa
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Acta Med Indones. 2025 Apr;57(2):175-199.
Patients with heart failure are often diagnosed based on clinical signs and serological markers. Finding biomarkers with greater sensitivity and specificity for heart failure patients who also have episodic dyspnea is a challenge for researchers. Thus, we conducted a systematic review and meta-analysis of previous research to determine the diagnostic value of B-type natriuretic peptide as a potential biomarker in heart failure patients experiencing acute dyspnea.
By searching PubMed/Medline, Scopus, and Google Scholar up to March 2023, all cross-sectional and cohort studies were selected according to the PRISMA guidelines and assessed by the Deeks' funnel plot asymmetry test for bias.
A total of thirty-five qualifying studies had their data extracted. In 26 investigations (n=16002), the precision of B-type natriuretic peptide was evaluated. There were significant differences in the reported sensitivity and specificity between trials. One research study yielded the lowest sensitivity of 0.76 (0.68, 0.82), with a prevalence of 46% for heart failure and a BNP level of ≥500 pg/ml. Specificity grew but stayed variable as the threshold rose, whereas sensitivity declined. A diagnostic meta-analysis was carried out on 14 trials (n=6313) to determine the accuracy of N-terminal probrain natriuretic peptide. When the threshold is raised, the pattern in NTproBNP is similar to that of B-type natriuretic peptides, with sensitivity falling and specificity increasing. Following the final analysis, the confidence areas surrounding the pooled sensitivity and specificity for BNP vs NTproBNP showed a distinct overlap. The overlap indicated that there was no statistically significant difference between the tests at the <100 pg/ml and ≤300 pg/ml rule-out levels, respectively (P>0.05).
The meta-analysis reveals a substantial degree of congruity in the sensitivity and specificity between the levels of BNP and NTproBNP as biomarkers. Nevertheless, it's worth noting that, in the end, there exists a potential for overlooking heart failure diagnoses. Larger future studies, overcoming past limitations, could likely establish a consensus.
心力衰竭患者通常根据临床体征和血清学标志物进行诊断。对于同时患有发作性呼吸困难的心力衰竭患者，寻找具有更高敏感性和特异性的生物标志物是研究人员面临的一项挑战。因此，我们对先前的研究进行了系统综述和荟萃分析，以确定B型利钠肽作为急性呼吸困难心力衰竭患者潜在生物标志物的诊断价值。
截至2023年3月，通过检索PubMed/Medline、Scopus和谷歌学术，根据PRISMA指南选择所有横断面研究和队列研究，并通过Deeks漏斗图不对称性检验评估偏倚。
共提取了35项符合条件的研究的数据。在26项研究（n = 16002）中，评估了B型利钠肽的准确性。各试验报告的敏感性和特异性存在显著差异。一项研究得出的最低敏感性为0.76（0.68，0.82），心力衰竭患病率为46%，脑钠肽水平≥500 pg/ml。随着阈值升高，特异性增加但仍存在变化，而敏感性下降。对14项研究（n = 6313）进行了诊断荟萃分析，以确定N末端脑钠肽前体的准确性。当阈值升高时，NTproBNP的模式与B型利钠肽相似，敏感性下降，特异性增加。最终分析后，BNP与NTproBNP合并敏感性和特异性周围的置信区间显示出明显重叠。重叠表明，在<100 pg/ml和≤300 pg/ml排除水平下，两种检测方法之间不存在统计学显著差异（P>0.05）。
荟萃分析表明，作为生物标志物，BNP和NTproBNP水平之间的敏感性和特异性存在高度一致性。然而，值得注意的是，最终仍存在漏诊心力衰竭的可能性。未来规模更大、克服了以往局限性的研究可能会达成共识。
