Elsevier

The American Journal of Medicine

Volume 118, Issue 11, November 2005, Pages 1287.e9-1287.e16
The American Journal of Medicine

Clinical research study
Use of N-terminal pro-B-type natriuretic peptide to detect myocardial ischemia

https://doi.org/10.1016/j.amjmed.2005.05.020Get rights and content

Abstract

Purpose

To evaluate the utility of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to detect myocardial ischemia.

Methods

We conducted a prospective observational study in 260 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography. Levels of NT-proBNP were determined before and immediately after symptom-limited bicycle ergometry.

Results

Inducible myocardial ischemia on perfusion images was detected in 129 patients (49.6%). Baseline NT-proBNP and exercise induced increase in NT-proBNP (ΔNT-proBNP) were significantly higher in patients with myocardial ischemia (median baseline NT-proBNP 155 pg/mL vs 91 pg/mL, P <.001; ΔNT-proBNP 15 pg/mL vs 7 pg/mL, P = .002). Compared with patients in the lowest ΔNT-proBNP quartile, those in the highest quartile of ΔNT-proBNP had three times the risk of inducible ischemia (relative risk, 2.9; 95% confidence interval, 1.4 to 6.0; P = .003). Overall, the accuracy of baseline NT-proBNP and ΔNT-proBNP in the detection of myocardial ischemia were similar to that of the exercise electrocardiogram (ECG). Combining exercise ECG and baseline NT-proBNP or ΔNT-proBNP slightly increased the accuracy of exercise ECG only.

Conclusion

The NT-proBNP level at rest as well as ΔNT-proBNP during exercise stress testing is associated with inducible myocardial ischemia. NT-proBNP levels may have incremental value in the diagnosis of myocardial ischemia.

Section snippets

Patient population

From May 2004 to August 2004, consecutive patients referred for coronary artery disease evaluation by rest/bicycle ergometry myocardial perfusion single-photon emission computed tomography at the University Hospital Basel were eligible for inclusion in this study. This cohort included patients with stable coronary artery disease as well as patients with unstable coronary artery disease after initial stabilization on medical therapy. Patients with baseline electrocardiogram (ECG) abnormalities

Patient characteristics

The baseline characteristics and details regarding exercise testing and myocardial perfusion single-photon emission computed tomography findings of the 260 patients referred to rest/bicycle ergometry myocardial perfusion single-photon emission computed tomography are listed in Table 1. At rest/ergometry stress myocardial perfusion single-photon emission computed tomography, an inducible ischemia on perfusion images was documented in 129 patients (49.6%).

Plasma NT-proBNP at rest and the response to exercise

The baseline NT-proBNP level (Table 2)

Discussion

This prospective study in unselected consecutive patients referred for rest/bicycle ergometry myocardial perfusion single-photon emission computed tomography examined the use of NT-proBNP measurements in the detection of myocardial ischemia defined as reversible defects on radionuclide imaging. We found that the baseline NT-proBNP, as well as ΔNT-proBNP and peak exercise NT-proBNP were associated with inducible myocardial ischemia. Overall, the accuracy of baseline NT-proBNP, ΔNT-proBNP, and

Acknowledgment

Diagnostic reagents were provided by Roche Diagnostics GmbH, Mannheim, Germany.

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    This study was supported by research grants from the Swiss National Science Foundation, and the Swiss Heart Foundation

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