Diagnostic value of N-terminal pro-brain natriuretic peptide for pleural effusion due to heart failure: a meta-analysis

Objective: To compare the efficacy and safety of conventional treatments (CTs) to those that included traditional Chinese medicine injections (TCMIs) in patients with combined coronary heart disease and heart failure (CHD-HF).Methods: Eight electronic literature databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure Database, Chinese Scientific Journal Database, Wanfang Database, Chinese Biomedical Database) were searched from their inceptions to May 18, 2021, to identify relevant randomised controlled trials (RCTs). The primary outcomes analyzed included the total effectiveness rate and adverse events (ADRs). The secondary outcomes analyzed included the left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and 6-min walk test (6MWT). Cochrane risk-of-bias tool was used to assess quality of the analyzed RCTs. Stata and OpenBUGS software were used to prior to the systematic review and network meta-analysis.Results: Sixty-one eligible trials involved 5,567 patients and one of the following 15 TCMIs: Shuxuetong, Shenmai, Shenfu, Shengmai, Danshenduofenyansuan, Danhong, Dazhuhongjingtian, Xinmailong, Dengzhanxixin, Gualoupi, Shuxuening, Xuesaitong, Yiqi Fumai, Shenqi Fuzheng, Huangqi. Network meta-analysis revealed that Shuxuetong injection + CT group was superior to CT only in improving the total effectiveness rate [odds ratio (OR): 7.8, 95% confidence interval (CI): 1.17–27.41]. Shenmai injection + CT was superior to CT only for LVEF (OR: 8.97, CI: 4.67–13.18), Xinmailong injection + CT was superior to CT only for NT-proBNP (OR: −317.70, CI: −331.10–303.10), Shenqi Fuzheng injection + CT was superior to CT only for BNP (OR: −257.30, CI: −308.40–242.80); and Danhong injection + CT was superior to CT only for 6MWT (OR: 84.40, CI: 62.62−106.20). Different TCMIs had different toxicity spectrums.Conclusion: TCMIs combined with CT are better than CT alone in treating CHD-HF. Different TCMIs improve different outcomes. Additional properly designed RCTs are needed to conduce a more refined comparison of various TCMIs.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021258263].

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Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies

Heart ◽

10.1136/heartjnl-2017-312781 ◽

2018 ◽

Vol 104 (15) ◽

pp. 1236.1-1237 ◽

Cited By ~ 4

Author(s):

Sander van Doorn ◽

Geert-Jan Geersing ◽

Rogier F Kievit ◽

Yvonne van Mourik ◽

Loes C Bertens ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Meta Analysis ◽

Diagnostic Value ◽

Community Dwelling ◽

Individual Participant Data ◽

Cut Point ◽

Individual Participant

ObjectiveHeart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF.MethodsIndividual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices.ResultsOf the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group.ConclusionsWith a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF.

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The diagnostic utility of brain natriuretic peptide in heart failure patients presenting with acute dyspnea: a meta-analysis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2012-0503 ◽

2013 ◽

Vol 51 (6) ◽

Cited By ~ 3

Author(s):

Paolo Mastandrea

Keyword(s):

Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Meta Analysis ◽

Heart Association ◽

Laboratory Method ◽

Significant Heterogeneity ◽

Acute Dyspnea ◽

Significant Difference ◽

Meta Regression

AbstractHeart failure with normal ejection fraction (HFNEF) accounts for approximately 50% of heart failure (HF) cases. To establish the utility of brain natriuretic peptide (BNP) in differentiating HF-related severe dyspnea from non-HF-related acute dyspnea, we used an estimation formula (eF) that was obtained from a series of three meta-regressions. We selected 60 out of 2721 case-control and follow-up studies that were published from 1998 to 2010. The heart failure levels (HFLs) were assessed using the New York Heart Association (NYHA) criteria. Random-effects meta-regression analyses of the natural logarithm (ln) of the BNP odds ratio (OR) were performed on the HFLs. The ln of the median BNP values (lnmBNP) was meta-regressed over the laboratory method (LM). A third meta-regression was performed on the HFLs to account for only the lnmBNP in the homogeneous LM subgroups. To determine the eF, the data from the diseased and control subjects were combined. The Bland-Altman method was used to detect eF bias. The overall BNP(OR) in the subgroup with severe HF was 35. The lnmBNP analysis showed that LM was a significant heterogeneity factor in the meta-regression (slope −0.38; CI −0.59 to −0.16). The meta-regression of lnmBNP on the HFL resulted in the following calculation for eF: estimated HFL (eHFL)=(lnmBNP–3.157)/0.886. The Bland-Altman test revealed no significant difference (0.0997; 95% CI −2.84 to 3.06) between HFL and eHFL. The severe eHFL showed a 78% accuracy. Based on the eF obtained from this meta-analysis, the BNP outcomes were shown to reliably diagnose severe dyspnea in HF and differentiate this condition from non-HF acute dyspnea.

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Significance of Brain Natriuretic Peptide Measurement as a Diagnostic Indicator of Cardiac Function

Methods of Information in Medicine ◽

10.1055/s-0038-1634337 ◽

2000 ◽

Vol 39 (03) ◽

pp. 249-253 ◽

Cited By ~ 21

Author(s):

N. Iida ◽

T. Ishihara ◽

S. Waku

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Diagnostic Value ◽

Left Ventricular ◽

Control Group ◽

Healthy Control ◽

Group 5 ◽

Lv Diastolic Dysfunction

AbstractBrain natriuretic peptide (BNP) is increased in patients with heart failure due to myocardial infarction and cardiac hypertrophy, in proportion to the severity of left ventricular dysfunction. The aims of this study were to clarify the clinical features of BNP and to determine the diagnostic value of BNP for mass screening.The subjects were 818 office workers (565 males and 253 females; mean age 47 ± 12 years) who participated in a 1996 routine health check at Kansai University All individuals were examined for blood pressure, serological findings, ECG and plasma BNP level. Thirty-three males underwent 2-D echocardiography. Plasma BNP levels were measured using IRMA (immunoradiometric assay).The results were as follows: (1) BNP levels in females were higher than those in males for healthy subjects (N = 551), in each age group from 20 to 60 years. (2) BNP levels increased with age. (3) There were significant correlations between BNP level and systolic blood pressure and creatinine level. (4) There were significant differences in BNP level between the hypertensive groups with and without hypertensive ECG changes and the age-matched healthy control group. (5) Marked correlations were observed between BNP level and left ventricular wall thickness, fractional shortening, deceleration time and peak early filling velocity. (6) A BNP cut-off-point of 25 pg/ml was best for detecting LV diastolic dysfunction and LV hypertrophy. Measurement of BNP is useful for detecting asymptomatic heart failure in the general population, and is a clinical marker useful in preventing symptomatic heart failure.

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THE ROLE OF BRAIN NATRIURETIC PEPTIDE-GUIDED HEART FAILURE THERAPY: AN UPDATED META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60743-3 ◽

2013 ◽

Vol 61 (10) ◽

pp. E743

Author(s):

Jae-Sik Jang ◽

Han-Young Jin ◽

Jeong-Sook Seo ◽

Tae-Hyun Yang ◽

Dae-Kyeong Kim ◽

...

Keyword(s):

Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Meta Analysis ◽

Heart Failure Therapy

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Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure

European Journal of Preventive Cardiology ◽

10.1177/1741826711409171 ◽

2011 ◽

Vol 19 (3) ◽

pp. 428-435 ◽

Cited By ~ 32

Author(s):

NA Smart ◽

T Meyer ◽

JA Butterfield ◽

SC Faddy ◽

C Passino ◽

...

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Outcome Measures ◽

Primary Outcome ◽

Meta Analysis ◽

Controlled Trials ◽

Heart Failure Patients ◽

Randomized Controlled

Background: Brain natriuretic peptide (BNP) predicts exercise performance and exercise training may modulate BNP and its N-terminal portion (NT-pro-BNP), we therefore conducted an individual patient analysis of exercise training effects on BNP and NT-pro-BNP. Aims: To use an individual patient meta-analysis to relate changes in BNP, NT-pro-BNP, and peak VO2; to link these changes to volume parameters of exercise training programmes (intensity etc.); and to identify patient characteristics likely to lead to greater improvements in BNP, NT-pro-BNP, and peak VO2. Design: Individual patient meta-analysis. Methods: A systematic search was conducted of Medline (Ovid), Embase.com, Cochrane Central Register of Controlled Trials, and CINAHL (until July 2008) to identify randomized controlled trials of aerobic and/or resistance exercise training in systolic heart failure patients measuring BNP and/or NT-pro-BNP. Primary outcome measures were change in BNP, NT-pro-BNP, and peak VO2. Subanalyses were conducted to identify (1) patient groups that benefit most and (2) exercise programme parameters enhancing favourable changes in primary outcome measures. Results: Ten randomized controlled studies measuring BNP or NT-pro-BNP met eligibility criteria, authors provided individual patient data for 565 patients (313 exercise and 252 controls). Exercise training had favourable effects on BNP (−28.3%, p < 0.0001), NT-pro-BNP (−37.4%, p = < 0.0001), and peak VO2 (17.8%, p < 0.0001). The analysis showed a significant change in primary outcome measures; moreover, change in BNP ( r = −0.31, p < 0.0001) and NT-pro-BNP ( r = −0.22, p < 0.0001) were correlated with peak VO2 change. Conclusion: Exercise training has favourable effects on BNP, NT-pro-BNP, and peak VO2 in heart failure patients and BNP/NT-pro-BNP changes were correlated with peak VO2 changes.

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