The American Journal of Medicine
Volume 122, Issue 3 , Pages 265-272, March 2009

B-Type Natriuretic Peptides for the Evaluation of Exercise Intolerance

  • Christian Mueller, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • Corresponding Author InformationRequests for reprints should be addressed to Christian Mueller, MD, FESC, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • ,
  • Micha T. Maeder, MD

      Affiliations

    • Department of Cardiology, University Hospital Basel, Switzerland
    • ,
  • Andreas Christ, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Tobias Reichlin, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Daniel Staub, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Markus Noveanu, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Tobias Breidthardt, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Mihael Potocki, MD

      Affiliations

    • Department of Internal Medicine, University Hospital Basel, Switzerland
    • ,
  • Martin H. Brutsche, MD, PhD

      Affiliations

    • Division of Pulmonary Care, University Hospital Basel, Switzerland

Abstract 

Background

Cardiopulmonary exercise testing is the method of choice for the differentiation of exercise intolerance. This study sought to assess the utility of B-type natriuretic peptide (BNP) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) for the identification of a cardiocirculatory exercise limitation.

Methods

In 162 patients undergoing cardiopulmonary exercise testing, rest and peak exercise BNP and NT-proBNP levels were measured. In 94 patients fulfilling criteria for appropriate effort and sufficient diagnostic certainty, the accuracy of BNP and NT-proBNP for the prediction of a cardiocirculatory limitation, as assessed based on clinical and exercise testing data, was determined.

Results

A cardiocirculatory limitation was identified in 27 (29%) patients. Median (interquartile range) resting BNP [162 (45-415) vs 39 (19-94) vs 24 (15-46) pg/mL; P <.001] and NT-proBNP [506 (129-1167) vs 77 (35-237) vs 34 (19-77) pg/mL; P <.001] were higher in patients with cardiocirculatory as compared with those with pulmonary limitation (n=28) and those without cardiocirculatory or pulmonary limitation (n=39). The area under the receiver operator characteristics curve for BNP and NT-proBNP to identify a cardiocirculatory limitation was 0.79 and 0.84, respectively (P=.15 for comparison of the curves). Sensitivity and specificity of the optimal BNP cutoff of 85 pg/mL were 63% and 84%, respectively. Sensitivity and specificity of the optimal NT-proBNP cutoff of 223 pg/mL were 74% and 85%, respectively. Peak exercise biomarkers were not more accurate than resting levels.

Conclusions

Among patients referred for cardiopulmonary exercise testing for evaluation of unexplained exercise intolerance, BNP and NT-proBNP were similarly useful to identify those with a cardiocirculatory limitation.

Keywords: Cardiopulmonary exercise testing, Exercise tolerance, Natriuretic peptides, Sensitivity, Specificity

 

 Funding: CM (Grant PP00B-102853) and MTM (Grant PBZHB-121007) are supported by the Swiss National Science Foundation.

 Conflicts of Interest: Dr. Mueller has received research support from Abbott, Biosite, Brahms, and Roche as well as speaker's honoraria from Abbott, Bayer, Biosite, Brahms, and Roche Diagnostic. The other authors have no possible conflicts of interest to declare. Diagnostic reagents were provided by Roche Diagnostics (Basel, Switzerland) and Abbott (Zug, Switzerland). The sponsors had no role in study design, data analysis, or interpretation.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)00986-8

doi:10.1016/j.amjmed.2008.08.030

The American Journal of Medicine
Volume 122, Issue 3 , Pages 265-272, March 2009

Article Tools

* Image Usage & Resolution