Background: Coronary heart disease is associated with increased B-type natriuretic peptides (BNPs), and, although controversial, may cause exaggerated exercise-induced BNP secretion. We investigated BNP in relation to reversible myocardial ischaemia. Materials and methods: Serum N-terminal proBNP (NTproBNP) was measured before and after an exercise electrocardiogram test (ETT) in 14 patients with and 45 patients without exercise-induced myocardial ischaemia. Statistical analysis was carried out on logarithmically transformed data. Results, however, are pre-transformed data.Results: NT-proBNP increased with exercise both in ETTpositive patients (mean (SD) 71.4 (41.2) v 76.8 (44.0) ng/l; p,0.001) and ETT-negative patients (54.0 (61.2) v 60.1 (69.0) ng/l; p,0.001). Pre-exercise and post-exercise NTproBNP were higher (p,0.05) in ETT-positive than in ETTnegative patients. Incremental NT-proBNP was similar in ETTpositive (4.7 (4.2) ng/l) and ETT-negative (6.2 (8.6) ng/l) patients. Conclusion: Serum NT-proBNP concentrations are higher in patients with exercise-induced myocardial ischaemia than in those without. Exercise-induced electrocardiographic myocardial ischaemia, however, is not associated with exaggerated BNP secretion.

Penney's excellent review on natriuretic peptides lists exercise prior to sampling as a potential cause for a false-positive brain natriuretic peptide (BNP) in relation to chronic heart failure (CHF). 1 This, however, is based on studies reporting a percentage rather than a more relevant absolute increase in BNP after exercise in healthy young men and marathon runners. 1 We studied serum N-terminal pro-brain natriuretic peptide (NT-proBNP) (Elecsys proBNP, Roche Diagnostics GmbH, Mannheim, Germany) during an exercise electrocardiogram test 2 in a more representative group of 64 patients without CHF (34 women and 30 men aged 56.5713.5 years [mean7SD]). Subjects exercised for 7.073.3 min to an intensity of 8.473.3 Metabolic Equivalents. Serum NT-proBNP, 15 min after exercise, was higher than at rest (59.3752.9 and 54.0747.8 ng/L, respectively; Po0.0001 [paired t-test]). The absolute and percentage increases in NT-proBNP after exercise were 5.176.2 ng/L and 11.279.2%, respectively. In all subjects, post-exercise serum NT-proBNP concentrations remained within age-and gender-derived reference ranges.McNairy et al. 3 reported that exercise increases BNP by 55%, 30% and 19% in controls, patients with mild CHF and patients with moderate to severe CHF, respectively. Of greater relevance, however, they similarly reported that post-exercise BNP values in control subjects were within the reference range. 3 Subjects presenting with dyspnoea are likely to have reduced exercise capacity. Pragmatically, therefore, exercise is unlikely to cause false-positive BNP 3 or NTproBNP results in patients being investigated for CHF.