Abstract
BackgroundAn overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking.MethodsWe performed a systematic literature search in PubMed and Embase.com (May 13, 2019). Studies were included when they (1) reported diagnostic performance measures, (2) are for the detection of DD or HFpEF in a non-acute setting, (3) are compared with a control group without DD or HFpEF or with patients with heart failure with reduced ejection fraction, (4) are in a cross-sectional design. Two investigators independently assessed risk of bias of the included studies according to the QUADAS-2 checklist. Results were meta-analysed when three or more studies reported a similar diagnostic measure.ResultsFrom 11,728 titles/abstracts, we included 51 studies. The meta-analysis indicated a reasonable diagnostic performance for both NPs for the detection of DD and HFpEF based on AUC values of approximately 0.80 (0.73–0.87; I2 = 86%). For both NPs, sensitivity was lower than specificity for the detection of DD and HFpEF: approximately 65% (51–85%; I2 = 95%) versus 80% (70–90%; I2 = 97%), respectively. Both NPs have adequate ability to rule out DD: negative predictive value of approximately 85% (78–93%; I2 = 95%). The ability of both NPs to prove DD is lower: positive predictive value of approximately 60% (30–90%; I2 = 99%).ConclusionThe diagnostic performance of NPs for the detection of DD and HFpEF is reasonable. However, they may be used to rule out DD or HFpEF, and not for the diagnosis of DD or HFpEF.
Highlights
An overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking
Our results indicate that NPs are useful to rule out DD or HFpEF in primary care with a low prevalence of these conditions but are less suitable to use to differentiate HFpEF from heart failure with reduced ejection fraction (HFrEF)
NPs should be used in combination with echocardiography for initial diagnosis of HFpEF, as guidelines recommend [3]
Summary
An overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking. Compared with cut-offs for NPs in current guidelines [3, 5, 6], up to one-third of all HFpEF outpatients have NP levels below the typical diagnostic thresholds and will be missed [8, 9]. This is alarming as obesity is a common comorbidity in HFpEF patients and is associated with lower NT-proBNP levels, which could lead to underdiagnosis of HFpEF [10,11,12]
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