Background

A number of circulating biomarkers are currently utilized for the diagnosis of chronic heart failure with preserved ejection fraction (HFpEF). However, due to HFpEF heterogeneity, the accuracy of these biomarkers remains unclear.

Aims

This study aimed to systematically determine the diagnostic accuracy of currently available biomarkers for chronic HFpEF.

Methods

PubMed, Web of Science, MEDLINE and SCOPUS databases were searched systematically to identify studies assessing the diagnostic accuracy of biomarkers of chronic HFpEF with left ventricular ejection fraction (LVEF) ≥ 50%. All included studies were independently assessed for quality and relevant information was extracted. Random-effects models were used to estimate the pooled diagnostic accuracy of HFpEF biomarkers.

Results

The search identified 6145 studies, of which 19 were included. Four biomarkers were available for meta-analysis. The pooled sensitivity of B-type natriuretic peptide (BNP) (0.787, 95% confidence interval [CI] 0.719–0.842) was higher than that of N-terminal pro-BNP (NT-proBNP) (0.696, 95% CI 0.599–0.779) in chronic HFpEF diagnosis. However, NT-proBNP showed improved specificity (0.882, 95% CI 0.778–0.941) compared to BNP (\0.796, 95% CI 0.672–0.882). Galectin-3 (Gal-3) exhibited a reliable diagnostic adequacy for HFpEF (sensitivity 0.760, 95% CI 0.631–0.855; specificity 0.803, 95% CI 0.667–0.893). However, suppression of tumorigenesis-2 (ST2) displayed limited diagnostic performance for chronic HFpEF diagnosis (sensitivity 0.636, 95% CI 0.465–0.779; specificity 0.595, 95% CI 0.427–0.743).

Conclusion

NT-proBNP and BNP appear to be the most reliable biomarkers in chronic HFpEF with NT-proBNP showing higher specificity and BNP showing higher sensitivity. Although Gal-3 appears more reliable than ST2 in HFpEF diagnosis, the conclusions are limited as only three studies were included in this meta-analysis.

中文翻译：

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评估射血分数保留的心力衰竭当前生物标志物的诊断准确性：系统评价和荟萃分析

背景

许多循环生物标志物目前用于诊断射血分数保留的慢性心力衰竭 (HFpEF)。然而，由于 HFpEF 的异质性，这些生物标志物的准确性仍不清楚。

宗旨

本研究旨在系统地确定目前可用的慢性 HFpEF 生物标志物的诊断准确性。

方法

对 PubMed、Web of Science、MEDLINE 和 SCOPUS 数据库进行了系统搜索，以确定评估左心室射血分数 (LVEF) ≥  50%的慢性 HFpEF 生物标志物诊断准确性的研究。所有纳入的研究均进行了独立的质量评估并提取了相关信息。随机效应模型用于估计 HFpEF 生物标志物的汇总诊断准确性。

结果

搜索确定了 6145 项研究，其中包括 19 项。四种生物标志物可用于荟萃分析。B 型利钠肽 (BNP) 的汇总敏感性 (0.787, 95% 置信区间 [CI] 0.719–0.842) 高于 N 端 pro-BNP (NT-proBNP) (0.696, 95% CI 0.599– 0.779) 在慢性 HFpEF 诊断中。然而，与 BNP (0.796, 95% CI 0.672–0.882) 相比，NT-proBNP 显示出更高的特异性 (0.882, 95% CI 0.778–0.941)。Galectin-3 (Gal-3) 对 HFpEF 表现出可靠的诊断充分性（敏感性 0.760，95% CI 0.631–0.855；特异性 0.803，95% CI 0.667–0.893）。然而，抑制肿瘤发生-2 (ST2) 对慢性 HFpEF 诊断的诊断性能有限（敏感性 0.636，95% CI 0.465–0.779；特异性 0.595，95% CI 0.427–0.743）。

结论

NT-proBNP 和 BNP 似乎是慢性 HFpEF 中最可靠的生物标志物，NT-proBNP 显示出更高的特异性，BNP 显示出更高的敏感性。尽管在 HFpEF 诊断中 Gal-3 似乎比 ST2 更可靠，但结论是有限的，因为该荟萃分析仅包括三项研究。