Heart failure & cardiomyopathiesDiagnostic or prognostic study
Evidence-Based Application of Natriuretic Peptides in the Evaluation of Chronic Heart Failure With Preserved Ejection Fraction in the Ambulatory Outpatient Setting
- Diagnostic accuracy study
- multicentre validation cohorts
Authors' conclusion
In patients with chronic unexplained dyspnea, current rule-in and rule-out NT-proBNP diagnostic thresholds lead to unacceptably high error rates, with important interactions by obesity and AF status.
Study context
- Population
- Patients with chronic dyspnea; Heart failure with preserved ejection fraction (HFpEF) or noncardiac dyspnea determined by exercise catheterization (derivation and validation cohorts 1–3), resting catheterization, previous HF hospitalization or exercise echocardiography (cohorts 4–6)derivation cohort n=414 + 6 validation cohorts
- Comparison
- NT-proBNP rule-out and rule-in thresholds, stratified by body mass index (BMI) and AF, for HFpEF diagnosis
- Outcome
- Diagnostic performance (sensitivity for rule-out, specificity for rule-in) of NT-proBNP thresholds for HFpEF
Performance
As reported in the abstract
Diagnostic performance in the derivation cohort
| Test or model | Sensitivity, BMI <35 kg/m² | Sensitivity, BMI ≥35 kg/m² | Specificity | Specificity, BMI <35 kg/m² | Specificity, BMI ≥35 kg/m² |
|---|---|---|---|---|---|
| Rule-out <125 pg/mL | 82% (95% CI, 77%-88%) | 67% (95% CI, 58%-77%) | |||
| Rule-out <50 pg/mL | 97% [95% CI, 95%-99%] | 86% [95% CI, 79%-93%] | |||
| Consensus rule-in | 65% (95% CI, 57%-72%) | ||||
| Rule-in ≥500 pg/mL | 85% (95% CI, 78%-91%) | 100% | |||
| Rule-in ≥220 pg/mL | 88% [95% CI, 73%-100%] |
Further findings
| Outcome | <50 pg/mL | ≥500 pg/mL | ≥220 pg/mL |
|---|---|---|---|
| Rule-out and rule-in thresholds in validation cohorts 1 and 2 | |||
| Sensitivity, BMI <35 (cohort 1) | 91% (95% CI, 88%-95%) | Not reported in the abstract | Not reported in the abstract |
| Sensitivity, BMI <35 (cohort 2) | 86% (95% CI, 80%-93%) | Not reported in the abstract | Not reported in the abstract |
| Sensitivity, BMI ≥35 (cohort 1) | 80% (95% CI, 74%-87%) | Not reported in the abstract | Not reported in the abstract |
| Sensitivity, BMI ≥35 (cohort 2) | 84% (95% CI, 74%-93%) | Not reported in the abstract | Not reported in the abstract |
| Specificity, BMI <35 (validation cohorts) | Not reported in the abstract | 87% [95% CI, 80%-94%] and 90% [95% CI, 81%-99%] | Not reported in the abstract |
| Specificity, BMI ≥35 (validation cohorts) | Not reported in the abstract | 93% [95% CI, 81%-100%] and 100% | 93% [95% CI, 81%-100%] and 100% |
Thresholds in validation cohorts 3 through 6
- Sensitivity of <50 pg/mL
- 93%-98%
- Specificity of ≥500 pg/mL
- 82%-89%
- Findings consistent with derivation
Patients with AF
- Patients with AF and dyspnea found to have HFpEF
- ≥98%
- NT-proBNP provided no incremental discrimination with history of AF
Original publication
Evidence-Based Application of Natriuretic Peptides in the Evaluation of Chronic Heart Failure With Preserved Ejection Fraction in the Ambulatory Outpatient Setting. Circulation. Published 22 January 2025. doi:10.1161/circulationaha.124.072156
Summarised from the published abstract; every number is checked against it