Review ArticleThe Biologic Variability of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide in Stable Heart Failure Patients
Section snippets
Design
This was a single-center study, approved by the medical ethics committee of St. Vincent's University Hospital and fulfilled the conditions of the Declaration of Helsinki. Patients were recruited from St. Vincent's University Hospital Heart Failure Unit. Informed consent was obtained from all patients.
Patient Population
Consecutive consenting heart failure patients reviewed at the unit over a 3-month period and deemed clinically stable by the attending physician were invited to participate in the study. Clinical
Results
Forty-five patients were enrolled in this study. The baseline demographics for this population are presented in Table 1. This sample is representative of a community-based heart failure population (69.6 ± 12.1 years, 64% male, 84% systolic heart failure, 62% ischemic etiology).
There was no symptomatic change, change in volume status, or medications (cardiac and noncardiac) between Week 1 and Week 2. Creatinine and body weight measurements were also similar (Week 1 versus Week 2: 167.0 ± 196.7
Discussion
The results of this study provide further insight into the usefulness of BNP in the management of heart failure. In contrast to the group means in which no significant differences were observed, the data demonstrate sizable intraindividual variability in clinically stable patients. This is evident both within 1 hour and in samples taken 1 week apart. The difference over 1 week is particularly large, with RCV values of 49.2 and 66.2% for NT-proBNP and BNP, respectively. This variability was as
Conclusions
Although analytic variability of BNP is greater than NT-proBNP, both assays have high biologic variability, which increases with time. This study suggests that changes approximating 50% and 66% for NT-proBNP and BNP, respectively, are needed to support a clinical suspicion of change in status over 1 week. Natriuretic peptides have a well-defined role as rule-out tests, in which differences in analytic variability may not be critical. However, further research is warranted to understand this
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