What is the clinical evidence from this study?

Study design: Case-Control. Population: Heart failure (n=186). Primary outcome: Diagnostic accuracy of serum and salivary NT-proBNP and hs-cTnI for heart failure diagnosis (AUC 0.97 for serum NT-proBNP, 95% CI 0.94-1.00, p=<0.001).

What question did this study set out to answer?

This study aims to evaluate the diagnostic potential of salivary biomarkers for heart failure by comparing them to serum levels.

February 26, 2026F1000Research0 citationsOpen Access

Evaluation of Cardiac Biomarkers in Serum and Saliva of Heart Failure Patients: A Two-Center Multicenter Study

Q: What are the key findings of this study?

Serum NT-proBNP demonstrated the highest diagnostic accuracy for heart failure with an AUC of 0.97, 93.0% sensitivity, and 97.7% specificity compared to controls.

Q: What question did this study set out to answer?

This study aims to evaluate the diagnostic potential of salivary biomarkers for heart failure by comparing them to serum levels.

TMTeba Saad Mohammed TMThikra Hasan Mathkor MHMuataz Fawzi Hussein

Key Result

Serum NT-proBNP demonstrated the highest diagnostic accuracy for heart failure with an AUC of 0.97, 93.0% sensitivity, and 97.7% specificity compared to controls.

Key Points

This study aims to evaluate the diagnostic potential of salivary biomarkers for heart failure by comparing them to serum levels.
Conducted a two-center, prospective case-control study examining heart failure patients and healthy controls.
Measured salivary and serum levels of NT-proBNP and hs-cTnI using sandwich ELISA.
Enrolled a total of 100 serum and 47 saliva from heart failure patients and matched controls while addressing sample limitations.
Heart failure patients exhibited significantly higher serum NT-proBNP and salivary NT-proBNP than controls (p < 0.001).
Salivary hs-cTnI was also significantly higher in HF patients compared to controls (p < 0.001).
Salivary NT-proBNP displayed a positive correlation with serum NT-proBNP, suggesting potential as a non-invasive diagnostic tool.

Study Design

Type

Case-Control (n=186)

Multicenter

Yes

Structured PICO

Does salivary NT-proBNP and hs-cTnI measurement accurately distinguish heart failure patients from healthy controls compared to serum measurement?

Population

200 participants (100 heart failure patients >18 years diagnosed per ESC criteria and 100 healthy controls). Patients had a median age of 61, 72% male. Excluded patients with severe COPD, uncontrolled dysthyroidism, chronic inflammatory intestinal diseases, severe rheumatological/oncological diseases, liver failure, and pregnancy.

Intervention

Measurement of salivary and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI) using sandwich ELISA

Comparator

Healthy controls

Outcome

Diagnostic performance (AUC, sensitivity, specificity) of serum and salivary NT-proBNP and hs-cTnI to distinguish heart failure patients from healthy controlssurrogate

Salivary NT-proBNP and hs-cTnI demonstrate moderate to good diagnostic potential for heart failure, suggesting saliva could serve as a complementary non-invasive monitoring tool.

Main Result

Effect estimate: AUC 0.97 for serum NT-proBNP (95% CI 0.94-1.00)

p-value: p=<0.001

Limitations

Limited sample size due to incomplete saliva and serum sampling may bias comparisons.
Salivary biomarker measurements prone to variability from flow rate, oral health, and matrix effects needing standardization.
Potential confounders like renal function, comorbidities, and medications were not fully controlled, affecting generalizability.

Abstract

Background Salivary biomarkers are being explored as non-invasive tools for Heart failure (HF) monitoring. This study examined salivary N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high sensitive cardiac troponin I (hs-cTnI) alongside serum levels to distinguish heart failure patients from healthy controls and to assess diagnostic potential and cross-matrix concordance. Method This two-center, prospective case-control study (Nov 2024–Apr 2025) enrolled heart failure patients and healthy controls, diagnosed per European Society of Cardiology criteria and confirmed by labs and echocardiography. Serum and saliva N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI) were measured by sandwich ELISA. Samples: 100 serum and 47 saliva from patients; 100 serum and 91 saliva from controls. Biomarkers were limited by serum volume (43 patients; 45 controls); saliva was measured in 47 patients and 45 controls. This limitation reduced the sample size for cardiac biomarker analyses relative to the total collected samples. Results HF patients showed higher serum NT-proBNP (309 220–399 ng/L) and salivary NT-proBNP (24 21–29 ng/L) versus controls (77 63–106 ng/L; 18 15–22 ng/L; P

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