Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina

Talwar, Suneel; Squire, Iain B.; Downie, Paul; Davies, Joan E.; Ng, Leong L.

doi:10.1136/heart.84.4.421

Cited by 122 publications

(93 citation statements)

References 20 publications

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“…15 A second study found no difference in resting BNP levels between 10 patients with stable angina and 15 control subjects. 17 However, a third study of 35 patients with known angina found that BNP levels increased after exercise. Indeed, the degree of BNP elevation corresponded with the size of ischemic territory, suggesting that inducible ischemia may lead to elevations in BNP.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] The possibility of an association between BNP and ischemia has been examined only in 3 small studies that have yielded conflicting results. [15][16][17] To determine whether circulating levels of BNP are associated with inducible ischemia, we measured resting BNP levels and performed exercise echocardiography in 355 patients with stable coronary disease.…”

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confidence: 99%

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

et al. 2003

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

et al. 2003

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“…The results of the present study suggest that BNP testing may be able to identify possible coronary artery disease in the absence of significant changes in resting ECG. Patients with unstable angina have been reported to exhibit elevated plasma BNP levels, 21,22) possibly due to ischemiainduced BNP production from the myocardium. 23) Although no subjects assigned to the coronary artery disease group in the present study showed clinically unstable angina, possible asymptomatic or subclinical myocardial ischemia due to exertion may increase myocardial BNP production and circulating levels.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Positive Cases for B-type Natriuretic Peptide and ECG Testing for Identification of Precursor Forms of Heart Failure in an Elderly Population

et al. 2005

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SUMMARYPlasma B-type natriuretic peptide (BNP) levels have been reported to be elevated in various types of cardiac disorders and in precursors of CHF. To elucidate the potential ability of BNP testing to identify individuals with structural cardiac disease (ie, hypertensive heart disease, coronary heart disease, valvular heart disease) among communitydwelling elderly persons, cases which were positive on BNP testing were compared to those positive on ECG testing.In the initial phase, we performed plasma BNP measurements and ECG in 856 participants (age ≥ 65 years) selected from a general population. From within this group, subjects with an abnormal ECG (n = 125) were selected according to the Minnesota code. Subjects with elevated BNP were selected independently on the basis of plasma levels (n = 112). In the next phase, subjects in both groups were invited to complete Rose's angina questionnaire and to undergo physical examination and transthoracic echocardiography. In this subject group (positive in ECG testing and/or BNP testing), the two tests had comparable sensitivity (65% versus 59%: NS) and specificity (40% versus 41%: NS) for identifying hypertensive heart disease (n = 17). For coronary heart disease (n = 12), the two tests had also comparable sensitivity (58% versus 42%: NS) and specificity (39% versus 41%: NS). However, for selection of valvular heart disease (n = 7), BNP testing had higher sensitivity than ECG testing (100% versus 14%; P < 0.01) with comparable specificity (43% versus 40%: NS).Several types of structural heart disease, in particular valvular heart disease, could be identified exclusively by BNP testing, suggesting that BNP measurement can make a significant contribution to screening for CHF precursors when used in combination with ECG in elderly populations. (Int Heart J 2005; 46: 477-487)

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“…In a subanalysis of the Prevention of Events With Angiotensin-Converting Enzyme Inhibition (PEACE) trial, which evaluated the prognostic value of baseline BNP and NTproBNP levels in 3761 patients with low-risk, stable coronary artery disease and preserved left ventricular function, 21 BNP was an independent predictor of an increased risk of heart failure development, while NTproBNP was independently 8,11,15,17,19,20,29 Non-ST-elevation myocardial infarction [11][12][13][14][15]17,20,27,29,32 Acute coronary syndrome in the absence of detectable myocardial necrosis (unstable angina) 9,12,13,15,27,29,32 Uncomplicated percutaneous coronary intervention in the presence of stable intracardiac filling pressure 12,16 Stable coronary artery disease 6,[21][22][23][24][25][26][28][29][30] natriuretic peptides in ACS july . august 2008 .…”

Section: Prognostic Value Of Natriuretic Peptides In Stable Coronary mentioning

confidence: 99%

“…[3][4][5] Beyond heart failure, recent studies indicate a role for natriuretic peptides in the setting of acute coronary syndrome (ACS). Myocardial ischemia, probably through increased regional ventricular wall stress, may trigger natriuretic peptide release [6][7][8][9] as a protective mechanism against ischemia-induced hemodynamic changes (Table I). 10 As a result, natriuretic peptides may be a new potential ACS biomarker, although their precise role is as yet incompletely defined.…”

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confidence: 99%

Natriuretic Peptides in Acute Coronary Syndromes: Prognostic Value and Clinical Implications

Farmakis

Filippatos

Tubaro

et al. 2008

Congestive Heart Failure

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Levels of natriuretic peptides, including B‐type natriuretic peptide and N‐terminal prohormone brain natriuretic peptide, are strong independent predictors of prognosis in acute coronary syndrome (ACS). They are associated with short‐and long‐term mortality and with the risk of new‐onset heart failure, above and beyond the conventional risk factors. Myocardial ischemia and ventricular wall stress are triggers for the release of natriuretic peptides, and although the latter are associated with the severity of the underlying coronary artery disease, they fail to predict recurrent nonfatal ACS. In conclusion, natriuretic peptide values may improve risk stratification in ACS when used in addition to troponin levels and other prognostic markers, but more data are needed to define their role in ACS therapy. Congest Heart Fail. 2008;14(4 suppl 1):25–29. ©2008 Le Jacq

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Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina

Cited by 122 publications

References 20 publications

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

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

Comparison of Positive Cases for B-type Natriuretic Peptide and ECG Testing for Identification of Precursor Forms of Heart Failure in an Elderly Population

Natriuretic Peptides in Acute Coronary Syndromes: Prognostic Value and Clinical Implications

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