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

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

  • Daniel Staub, MD

      Affiliations

    • Department of Internal Medicine, Basel, Switzerland
    • ,
  • Nils Jonas, MD

      Affiliations

    • Department of Internal Medicine, Basel, Switzerland
    • ,
  • Michael J. Zellweger, MD

      Affiliations

    • Division of Cardiology, Basel, Switzerland
    • ,
  • Charly Nusbaumer, PhD

      Affiliations

    • Department of Laboratory Medicine, Basel, Switzerland
    • ,
  • Damian Wild, MD

      Affiliations

    • Department of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
    • ,
  • Matthias E. Pfisterer, MD

      Affiliations

    • Division of Cardiology, Basel, Switzerland
    • ,
  • Jan Mueller-Brand, MD

      Affiliations

    • Department of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
    • ,
  • André P. Perruchoud, MD

      Affiliations

    • Department of Internal Medicine, Basel, Switzerland
    • ,
  • Christian Mueller, MD

      Affiliations

    • Department of Internal Medicine, Basel, Switzerland
    • Corresponding Author InformationRequests for reprints should be addressed to Dr. Christian Müller, Medizinische Klinik A, Universitätsklinik, Petersgraben 4, CH-4031 Basel, Switzerland

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.

Keywords:  Natriuretic peptides , Ischemia , Exercise , Electrocardiography

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

PII: S0002-9343(05)00398-0

doi:10.1016/j.amjmed.2005.05.020

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

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