Elsevier

American Heart Journal

Volume 151, Issue 6, June 2006, Pages 1223-1230
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Use of B-type natriuretic peptide in the detection of myocardial ischemia

https://doi.org/10.1016/j.ahj.2005.06.045Get rights and content

Background

Exercise electrocardiography (ECG) has high specificity but limited sensitivity for the detection of myocardial ischemia. The aim of this study was to determine whether measurement of B-type natriuretic peptide (BNP) can improve the diagnostic accuracy of exercise ECG.

Methods

A total of 256 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography were enrolled. Levels of BNP were determined before and 1 minute after maximal exercise.

Result

Inducible myocardial ischemia on perfusion images was detected in 127 patients (49.6%). Median BNP levels at rest and after peak exercise were higher in patients with than without inducible ischemia (71 pg/mL vs 38 pg/mL, P < .001; and 88 vs 52 pg/mL, P < .001, respectively). Compared with patients in the lowest peak exercise BNP quartile, those in the highest quartile of peak exercise BNP had more than 3 times the risk of inducible ischemia (adjusted relative risk 3.3, 95% CI 1.3-8.6, P = .015). Using 110 pg/mL as a cutoff, the combination of exercise ECG and peak exercise BNP level distinguished between ischemic and nonischemic patients more accurately than the exercise ECG alone (67% vs 60%, P = .024). Although the increase in accuracy was similar for the combination of exercise ECG with baseline BNP or ΔBNP, overall, peak exercise BNP seemed to be the preferred measurement.

Conclusions

B-type natriuretic peptide levels are associated with inducible myocardial ischemia. The use of BNP levels improves the diagnostic accuracy of exercise ECG.

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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  • Cited by (0)

    The sponsors had no role in the study design, data analysis, or interpretation.

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