B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

Abstract

Background-In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as myocardial ischemia may also cause elevations in BNP. Methods and Results-To determine whether BNP elevations are associated with myocardial ischemia, we measured plasma BNP levels before performing exercise treadmill testing with stress echocardiography in outpatients with stable coronary disease. Of the 355 participants, 113 (32%) had inducible ischemia. Compared with participants in the lowest BNP quartile (0 to 16.4 pg/mL), those in the highest quartile of BNP (Ն105 pg/mL) had double the risk of inducible ischemia (adjusted relative risk, 2.0; 95% CI, 1.2 to 2.6; Pϭ0.008). The relation between elevated BNP levels and inducible ischemia was especially evident in the 206 participants who had a history of myocardial infarction (adjusted relative risk, 2.6; 95% CI, 1.5 to 3.7, Pϭ0.002) and was absent in those without a history of myocardial infarction (adjusted relative risk, 1.0; 95% CI, 0.3 to 2.2; Pϭ0.9). This association between BNP levels and inducible ischemia remained strong after adjustment for measures of systolic and diastolic dysfunction. Conclusions-Elevated levels of BNP are independently associated with inducible ischemia among outpatients with stable coronary disease, particularly among those with a history of myocardial infarction. The observed association between BNP levels and ischemia may explain why tests for BNP are not specific for ventricular dysfunction among patients with coronary disease.

N-Terminal Pro-B–Type Natriuretic Peptide Is Related to Retinal Microvascular Damage

“…These associations were independent of cardiovascular risk factors. Thus far, evidence of a role of NT-proBNP in cardiovascular disease comes primarily from research focused on coronary heart disease 15 and heart failure. 16 In addition, it is increasingly being suggested that NT-proBNP might be a general marker of vascular disease beyond specific heart disease.…”

Serum high-sensitivity C-reactive protein, amyloid-associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

“…In addition, it has also been shown that increases in NT-proBNP levels were related to the extent and severity of the coronary artery disease 28. Serum NT-proBNP was found to be a strong predictor for future cardiovascular events in patients with stable angina pectoris 29…”

Diagnostic accuracy of serum B-type natriuretic peptide for myocardial ischemia detection during exercise testing with Spect perfusion imaging

“…Recently some studies found a rise in BNP during transient ischemia and during acute coronary syndrome [17][18][19], even in those without evidence of heart failure [20]. ProBNP levels were found to correlate with peak troponin-T in patients with non-ST elevation myocardial infarction [21].…”