A meta-analysis of 35 studies found that BNP and NT-proBNP peptide biomarkers have comparable diagnostic accuracy for heart failure in patients with acute dyspnea, though some cases may still be missed.
No significant differenceBNP and NT-proBNP showed overlapping sensitivity and specificity for heart failure diagnosis across 35 studies, confirming either biomarker is appropriate
What the researchers found
BNP (B-type natriuretic peptide) and NT-proBNP showed comparable diagnostic accuracy for heart failure in patients presenting with acute dyspnea. Across 26 studies (n=16,002) for BNP and 14 studies (n=6,313) for NT-proBNP, pooled sensitivity and specificity overlapped with no statistically significant difference between the two biomarkers.
As with any threshold-dependent test, raising the BNP cutoff increased specificity but decreased sensitivity. The lowest reported sensitivity was 0.76 at a BNP cutoff of ≥500 pg/mL in a study with 46% heart failure prevalence. The authors note a residual risk of missed heart failure diagnoses with either biomarker.
Why it matters
Acute dyspnea (sudden shortness of breath) is one of the most common emergency department presentations, and quickly distinguishing heart failure from other causes is critical for treatment. BNP and NT-proBNP are the most widely used peptide biomarkers for this purpose. This meta-analysis confirms that both perform similarly, giving clinicians confidence that either test is appropriate, while also highlighting that neither is perfect — some heart failure cases will still be missed.
The numbers in context
35 qualifying studies · BNP: 26 studies, n=16,002 · NT-proBNP: 14 studies, n=6,313 · Lowest BNP sensitivity: 0.76 at ≥500 pg/mL · No significant difference between BNP and NT-proBNP (p>0.05)
How the study worked
Systematic review and meta-analysis following PRISMA guidelines. The researchers searched PubMed/Medline, Scopus, and Google Scholar through March 2023 for cross-sectional and cohort studies evaluating BNP and NT-proBNP in heart failure patients with acute dyspnea. Publication bias was assessed using Deeks' funnel plot asymmetry test. Diagnostic accuracy (sensitivity and specificity) was pooled across studies.
Who was studied
Heart failure patients presenting with acute dyspnea (across 35 studies)
What this study cannot tell us
Significant heterogeneity existed between studies in reported sensitivity and specificity, likely reflecting different BNP cutoff thresholds, patient populations, and heart failure prevalence. The search only extended through March 2023. The authors acknowledge that larger future studies are needed to establish consensus cutoff values. Some heart failure cases may be missed by either biomarker.
How to read the evidence
This is a systematic review and meta-analysis — the highest level of evidence synthesis — pooling data from 35 studies and over 22,000 patients. However, significant between-study heterogeneity and the inherent limitations of diagnostic accuracy studies temper the certainty of specific threshold recommendations.
When this study was published
Published in 2025 with a literature search through March 2023. BNP and NT-proBNP are well-established biomarkers with decades of research, so the findings remain clinically relevant despite the search cutoff.
The bigger picture
BNP and NT-proBNP are among the most clinically important peptide biomarkers in medicine, used millions of times annually worldwide to help diagnose heart failure. This meta-analysis reinforces their established clinical role while highlighting an ongoing challenge: no single blood test perfectly separates heart failure from other causes of breathlessness. The results support current guidelines that recommend either biomarker and emphasize the need for clinical judgment alongside lab results.
Questions still open
- Would age- and sex-specific BNP cutoff values improve diagnostic accuracy in different patient populations?
- Can combining BNP/NT-proBNP with other emerging biomarkers reduce the rate of missed heart failure diagnoses?
- How do BNP and NT-proBNP perform specifically in patients with heart failure with preserved ejection fraction (HFpEF), which is notoriously harder to diagnose?
Common questions
What is BNP and why does the heart release it?
If BNP and NT-proBNP are the same, why do hospitals test for different ones?
Read the original research
The Diagnostic Utility of Brain Natriuretic Peptide in Heart Failure Patients Presenting with Acute Dyspnea: A Systematic Review and Meta-analysis.
Acta medica Indonesiana, 57(2), 175-199
Citation
Karimi, Mohammad Amin; Kazemi Ferezghi, Zahra; Khademi, Reza; Mazhari, Seyed Amirhossein; Chichagi, Fatemeh; Rasouli, Asma; Alikhani, Reyhaneh; Sani, Anis; Akhavan Rezayat, Shima; Shakouri, Nima; Azimi, Seyed Iraj; Jadidian, Faezeh; Nikeghbali, Golnaz; Edrisian, Mahfam; Alizadeh, Alaleh; Deravi, Niloofar; Poudineh, Mohadeseh; Asadi Anar, Mahsa. (2025). The Diagnostic Utility of Brain Natriuretic Peptide in Heart Failure Patients Presenting with Acute Dyspnea: A Systematic Review and Meta-analysis.. Acta medica Indonesiana, 57(2), 175-199.