December 30, 2021Clinical CardiologyOpen Access

Natriuretic peptides to differentiate constrictive pericarditis and restrictive cardiomyopathy: A systematic review and meta‐analysis

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Why the study?

Previous studies indicated that natriuretic peptide levels are elevated in restrictive cardiomyopathy but not in constrictive pericarditis, prompting an evaluation of the diagnostic utility of BNP and NT-proBNP to differentiate the two conditions.

Do BNP and NT-proBNP levels accurately differentiate constrictive pericarditis from restrictive cardiomyopathy in adult patients?

Structured PICO

Do BNP and NT-proBNP levels accurately differentiate constrictive pericarditis from restrictive cardiomyopathy in adult patients?

Population

204 adult patients from 7 studies (4 case-control, 3 cohorts) with constrictive pericarditis or restrictive cardiomyopathy, mean age range 25.7-64.1 years, 77% men.

Intervention

Measurement of B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels

Comparator

Constrictive pericarditis versus restrictive cardiomyopathy

Outcome

Diagnostic utility to differentiate constrictive pericarditis and restrictive cardiomyopathy (measured by standardized median difference and area under the curve)surrogate

BNP and NT-proBNP levels are significantly lower in constrictive pericarditis compared to restrictive cardiomyopathy, providing good diagnostic accuracy to differentiate the two conditions.

Implication

Supports BNP testing to differentiate constrictive pericarditis from restrictive cardiomyopathy; confirms diagnostic accuracy in pooled analysis.

Abstract

Previous studies have shown that natriuretic peptide levels are increased in patients with restrictive cardiomyopathy (RCM) but not in constrictive pericarditis (CP). We performed a systematic review and meta-analysis to evaluate the diagnostic utility of B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate CP and RCM. We searched electronic databases from inception to January 07, 2021. Studies involving adult patients that assessed the utility of natriuretic peptides to differentiate CP and RCM were included. All meta-analyses were performed using a random-effects model. Seven studies (four case-control and three cohorts) involving 204 patients were included. The mean age ranged between 25.7 and 64.1 years and 77% of patients were men. BNP levels were significantly lower (standardized median difference [SMD], -1.48; 95% confidence interval [CI], -2.33 to -0.63) in patients with CP compared to RCM. The pooled area under the curve (AUC) of the BNP level was 0.81 (95% CI, 0.70-0.92). NT-proBNP (SMD, -0.86; 95% CI, -1.38 to -0.33) and log NT-proBNP (SMD, -1.89; 95% CI, -2.59 to -1.20) levels were significantly lower in patients with CP compared to RCM. Our review shows that BNP and NT-proBNP levels were significantly lower in patients with CP compared to RCM. The pooled AUC of BNP level showed a good diagnostic accuracy to differentiate both conditions.