BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

Abstract

BackgroundRecent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events.ObjectivesTo determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS).MethodsThis study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%.ResultsThe mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia.ConclusionsBNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

Valores intermediários de BNP são capazes de predizer eventos em pacientes com síndrome coronária aguda?

“…Estudo realizado por Azevedo et al 6 já apontava que mesmo em valores reduzidos, o BNP poderia ser um marcador importante em pacientes com SCA. Avaliando 125 pacientes com dor torácica e comparando o resultado no BNP com a cintilografia de perfusão miocárdica, os autores demonstraram um índice de acurácia de 66% relacionado ao BNP para detecção de isquemia quando este era maior que 80 pg/mL.…”

“…Avaliando 125 pacientes com dor torácica e comparando o resultado no BNP com a cintilografia de perfusão miocárdica, os autores demonstraram um índice de acurácia de 66% relacionado ao BNP para detecção de isquemia quando este era maior que 80 pg/mL. Além disso, acima desse valor, existia clara relação com a mortalidade (RR=7,29, p = 0,045) 6 . De maneira muito semelhante, outro estudo mostrou em 723 pacientes com dor torácica e/ou SCA sem supradesnível de ST que o risco de morte quando o BNP é maior que 101 pg/mL é 13 vezes maior em 30 dias (p < 0,0001) e 5,3 vezes maior em um ano (p < 0,0001) 21 .…”

“…Diversos estudos apresentaram valores de corte únicos através dos quais o BNP encontrou-se relacionado a piores desfechos em SCA [6][7][8][9][10][11][12][13][14][15][16] . No entanto, a análise específica de valores intermediários ainda não foi descrita.…”

An Investigation into the Relationship between N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) and Fragmented QRS in Patients with Chronic Heart Failure

“…(10) The injured tissues around an infarct scar may lead to RSR' pattern in the QRS. (11) Despite the fact the past research has focused on the relationship between cardiac complications and fQRS, there is still little information about the prognostic and diagnostic values of the QRS complex abnormalities. According to some studies, fQRS was associated with arrhythmic events and mortality in patients with structural heart disease (SHD).…”

Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention

“…Diabetes mellitus, hypertension and hyperlipidemia are known risk factors for ischemic heart disease and may cause greater myocardial remodeling and dysfunction. N-terminal pro-brain natriuretic peptide (NT-proBNP) is produced and released by cardiac ventricles in response to an overload in ventricular wall stress and stimulation by myocardial tissue reperfusion ( 8 ). NT-proBNP, a biomarker, is used to predict short- and long-term mortality in patients with STEMI, as it is closely linked to the level of inflammation, neurohormonal responses and heart function in patients ( 9 – 11 ).…”