Clinical InvestigationAcute Ischemic Heart DiseaseUse of B-type natriuretic peptide in the detection of myocardial ischemia
Section snippets
Patient population
From May 2004 to August 2004, consecutive patients referred for CAD evaluation by rest/bicycle ergometry myocardial perfusion SPECT at the University Hospital Basel were eligible for inclusion in the BNP for Ischemia Evaluation (BASEL IV) study. This cohort included patients with stable CAD as well as patients with unstable CAD after initial stabilization on medical therapy. Patients with baseline ECG abnormalities that make the stress ECG uninterpretable, including preexcitation,
Patient characteristics
The characteristics of the 256 patients referred to rest/bicycle ergometry stress myocardial perfusion SPECT are listed in Table I. An inducible ischemia on perfusion images was documented in 127 patients (49.6%).
BNP levels at rest and after peak exercise
As shown in Table II, BNP at rest, BNP 1 minute after peak exercise, and increase in plasma concentration during exercise for BNP (ΔBNP) were all significantly higher in patients with inducible ischemia than in patients without ischemia. B-type natriuretic peptide levels were better
Discussion
This prospective study in unselected consecutive patients referred for rest/bicycle ergometry myocardial perfusion SPECT examined the use of BNP measurements in the detection of myocardial ischemia. We report 4 major findings. First, baseline BNP, peak exercise BNP, and ΔBNP are significantly associated with inducible ischemia. Second, the use of the combination of exercise ECG with any of the BNP levels increased diagnostic accuracy as compared with exercise ECG only. Third, applying this
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The sponsors had no role in the study design, data analysis, or interpretation.