Age-stratified NT-proBNP decision limits improved diagnostic performance over a single 125 ng/L cut-point for ruling out reduced left ventricular systolic function, with an overall AUC of 0.89.
Meta-Analysis (n=5,508)
Yes
Do age-stratified NT-proBNP decision limits improve diagnostic performance for ruling out suspected systolic dysfunction in primary care patients compared to a single cut-point?
Age-stratified NT-proBNP cut-offs significantly improve the diagnostic accuracy and negative predictive value for ruling out systolic heart failure in primary care compared to a single threshold.
Effect estimate: AUC 0.89
AIMS: The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards. METHODS AND RESULTS: Data were obtained from 5508 patients from 10 studies in the UK, New Zealand, Europe, and USA. All have had NT-proBNP analysis and echocardiography. The median age was 62 years (range 18-100 years) with a prevalence of reduced left ventricular systolic function (left ventricular ejection fraction 75 years. Using optimized decision limits, sensitivity, specificity, and negative predictive values (NPVs) were: 75 years (250 ng/L): 87.9, 53.7, and 92.4%, respectively. Using only a single decision value (125 ng/L for all ages) gave sensitivities of 89.1, 91.9, and 94.3%; specificities of 84.0, 69.1, and 29.3% and NPVs of 97.7, 97.6, and 93.4%. A decision value of 400 ng/L for all ages gave much lower sensitivities. CONCLUSION: In a large population of patients in primary care, the use of age-stratified NT-proBNP decision limits considerably improves performance over current standards, with an excellent NPV for exclusion of reduced left ventricular systolic function.
Hildebrandt et al. (Wed,) conducted a meta-analysis in Suspected systolic dysfunction (n=5,508). Age-related decision limits for NT-proBNP vs. Single decision value (125 ng/L or 400 ng/L) was evaluated on Ruling out reduced left ventricular systolic function (LVEF ≤40%) (AUC 0.89). Age-stratified NT-proBNP decision limits improved diagnostic performance over a single 125 ng/L cut-point for ruling out reduced left ventricular systolic function, with an overall AUC of 0.89.