Coronary artery diseaseRelation of N-Terminal Pro B-Type Natriuretic Peptide Levels After Symptom-Limited Exercise to Baseline and Ischemia Levels
Section snippets
Methods
One hundred one consecutive patients referred for evaluation of the presence or absence of inducible myocardial ischemia and able to perform a bicycle exercise test and subsequent 6-hour blood sampling were included. Patients underwent symptom-limited exercise myocardial perfusion scintigraphy according to a 2-day stress/rest protocol using technetium-99m–tetrofosmin and electrocardiogram (ECG)-gated single-photon emission computed tomography. Blood samples for analysis of NT-proBNP were
Results
Clinical and biochemical characteristics of patients according to the presence or absence of ischemia are listed in Table 1. Patients with ischemia (SDS ≥3; n = 37; 37%) more often were men and more often had a history of coronary artery disease and myocardial infarction and a positive exercise ECG. Baseline NT-proBNP was higher in patients with ischemia (median 184 pg/ml, interquartile range 57 to 386 vs 74, interquartile range 21 to 255 in patients without ischemia, p = 0.043). Table 2 lists
Discussion
Our study showed that after exercise, there was both an immediate and a secondary increase in circulating NT-proBNP. In a multivariate model for the prediction of either an immediate or secondary increase, the presence of myocardial ischemia on the perfusion scan did not add predictive information. Conversely, baseline NT-proBNP in multivariate analysis improved the model significantly. Baseline NT-proBNP was also associated with end-systolic volume and creatinine clearance in multivariate
Acknowledgment
We thank A.H. Zwinderman for statistical assistance and C. Behrens, MD, for assistance in blood sampling and handling.
References (29)
- et al.
Plasma N-terminal pro-B-type natriuretic peptide for prediction of death or nonfatal myocardial infarction following percutaneous coronary intervention
Am J Cardiol
(2004) - et al.
N-Terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris
Am Heart J
(2004) - et al.
Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia
J Am Coll Cardiol
(2004) - et al.
ACC/AHA 2002 guideline update for exercise testing: summary articleA report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines)
J Am Coll Cardiol
(2002) - et al.
Automatic quantitation of regional myocardial wall motion and thickening from gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography
J Am Coll Cardiol
(1997) - et al.
Usefulness of plasma brain natriuretic peptide levels in predicting dobutamine-induced myocardial ischemia
Am J Cardiol
(2004) - et al.
Usefulness of brain natriuretic peptide levels to discriminate patients with stable angina pectoris without and with electrocardiographic myocardial ischemia and patients with healed myocardial infarction
Am J Cardiol
(2004) - et al.
Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Biological variation for N-terminal pro- and B-type natriuretic peptides and implications for therapeutic monitoring of patients with congestive heart failure
Am J Cardiol
(2003) - et al.
Natriuretic peptides
N Engl J Med
(1998)
N-Terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients
Circulation
N-Terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease
N Engl J Med
The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes
N Engl J Med
Clinical relevance of cardiac natriuretic peptides measured by means of competitive and non-competitive immunoassay methods in patients with renal failure on chronic hemodialysis
J Endocrinol Invest
Cited by (10)
N-terminal pro B-type natriuretic peptide identifies patients with chest pain at high long-term cardiovascular risk
2011, American Journal of MedicineCitation Excerpt :This finding may be explained in 2 ways. First, ongoing myocardial ischemia at presentation may cause a temporary left ventricular dysfunction and subsequent release of NT-proBNP.21 Second, elevated NT-proBNP levels may result from previous myocardial damage and consequent deterioration of left ventricular function.
Determinants of absolute and relative exercise-induced changes in B-type natriuretic peptides
2011, International Journal of CardiologyCitation Excerpt :Based on the assumption that cardiomyocyte stretch and cardiac wall stress respectively are the major stimuli for cardiac BNP release [12,13], it has been hypothesized that exercise-associated changes in circulating B-type natriuretic peptides may reflect changes in left ventricular filling pressures and thereby exercise-induced myocardial ischemia [10]. However, studies evaluating the utility of exercise-induced changes in BNP or NT-proBNP for the detection of inducible myocardial ischemia have revealed conflicting results [2,6,7,9,10,14,15]. Nonetheless, the phenomenon of exercise-induced changes in BNP and NT-proBNP is interesting as it challenges the assumption that BNP plasma concentrations are largely regulated on the transcriptional level [16].
Exercise-induced change in circulating NT-proBNP could not distinguish between patients with and without coronary artery disease: the CADENCE study
2022, Scandinavian Cardiovascular JournalStronger correlation with myocardial ischemia of high-sensitivity troponin T than other biomarkers
2019, Journal of Nuclear Cardiology