Use of N-terminal pro-B-type natriuretic peptide to detect myocardial ischemia

被引：68

作者：

Staub, Daniel ^{[1
]}

Jonas, Nils ^{[1
]}

Zellweger, Michael J. ^{[2
]}

Nusbaumer, Charly ^{[3
]}

Wild, Damian ^{[4
]}

Pfisterer, Matthias E. ^{[2
]}

Mueller-Brand, Jan ^{[4
]}

Perruchoud, Andre P. ^{[1
]}

Mueller, Christian ^{[1
]}

机构：

[1] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, Div Cardiol, CH-4031 Basel, Switzerland

[3] Univ Basel Hosp, Dept Lab Med, CH-4031 Basel, Switzerland

[4] Univ Basel Hosp, Dept Nucl Med, CH-4031 Basel, Switzerland

来源：

AMERICAN JOURNAL OF MEDICINE | 2005年 / 118卷 / 11期

基金：

瑞士国家科学基金会;

关键词：

Natriuretic peptides; Ischemia; Exercise; Electrocardiography;

D O I：

10.1016/j.amjmed.2005.05.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

PURPOSE: To evaluate the utility of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to detect myocardial ischemia. METHODS: We conducted a prospective observational study in 260 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography. Levels of NT-proBNP were determined before and immediately after symptom-limited bicycle ergometry. RESULTS: Inducible myocardial ischemia on perfusion images was detected in 129 patients (49.6%). Baseline NT-proBNP and exercise induced increase in NT-proBNP ( Delta NT-proBNP) were significantly higher in patients with myocardial ischemia (median baseline NT-proBNP 155 pg/mL vs 91 pg/mL, P <.001; Delta NT-proBNP 15 pg/mL vs 7 pg/mL, P < .002). Compared with patients in the lowest Delta NT-proBNP quartile, those in the highest quartile of Delta NT-proBNP had three times the risk of inducible ischemia (relative risk, 2.9; 95% confidence interval, 1.4 to 6.0; P < .003). Overall, the accuracy of baseline NT-proBNP and Delta NT-proBNP in the detection of myocardial ischemia were similar to that of the exercise electrocardiogram (ECG). Combining exercise ECG and baseline NT-proBNP or Delta NT-proBNP slightly increased the accuracy of exercise ECG only. CONCLUSION: The NT-proBNP level at rest as well as Delta NT-proBNP during exercise stress testing is associated with inducible myocardial ischemia. NT-proBNP levels may have incremental value in the diagnosis of myocardial ischemia. (C) 2005 Elsevier Inc. All rights reserved.

引用

页码：1287.e9 / 1287.e16

页数：8

共 32 条

[1] Usefulness of plasma brain natriuretic peptide levels in predicting dobutamine-induced myocardial ischemia [J].

Asada, J ;

Tsuji, H ;

Iwasaka, T ;

Thomas, JD ;

Lauer, MS .

AMERICAN JOURNAL OF CARDIOLOGY, 2004, 93 (06) :702-704

[2] SEPARATE ACQUISITION REST THALLIUM-201/STRESS TC-99M SESTAMIBI DUAL-ISOTOPE MYOCARDIAL PERFUSION SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY - A CLINICAL VALIDATION-STUDY [J].

BERMAN, DS ;

KIAT, H ;

FRIEDMAN, JD ;

WANG, FP ;

VANTRAIN, K ;

MATZER, L ;

MADDAHI, J ;

GERMANO, G .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (05) :1455-1464

[3] B-type natriuretic peptide and ischemia in patients with stable coronary disease - Data from the Heart and Soul Study [J].

Bibbins-Domingo, K ;

Ansari, M ;

Schiller, NB ;

Massie, B ;

Whooley, MA .

CIRCULATION, 2003, 108 (24) :2987-2992

[4] ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations - A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina) [J].

Braunwald, E ;

Antman, EM ;

Beasley, JW ;

Califf, RM ;

Cheitlin, MD ;

Hochman, JS ;

Jones, RH ;

Kereiakes, D ;

Kupersmith, J ;

Levin, TN ;

Pepine, CJ ;

Schaeffer, JW ;

Smith, EE ;

Steward, DE ;

Theroux, P ;

Gibbons, RJ ;

Alpert, JS ;

Eagle, KA ;

Faxon, DP ;

Fuster, V ;

Gardner, TJ ;

Gregoratos, G ;

Russell, RO ;

Smith, SC .

CIRCULATION, 2000, 102 (10) :1193-1209

[5] PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].

COCKCROFT, DW ;

GAULT, MH .

NEPHRON, 1976, 16 (01) :31-41

[6] PLASMA BRAIN NATRIURETIC PEPTIDE IN ASSESSMENT OF ACUTE DYSPNEA [J].

DAVIS, M ;

ESPINER, E ;

RICHARDS, G ;

BILLINGS, J ;

TOWN, I ;

NEILL, A ;

DRENNAN, C ;

RICHARDS, M ;

TURNER, J ;

YANDLE, T .

LANCET, 1994, 343 (8895) :440-444

[7] COMPARATIVE EFFECTS OF ISCHEMIA AND HYPOXEMIA ON LEFT-VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN HUMANS [J].

DEBRUYNE, B ;

BRONZWAER, JGF ;

HEYNDRICKX, GR ;

PAULUS, WJ .

CIRCULATION, 1993, 88 (02) :461-471

[8] Detection of exercise-induced ischemia by changes in B-type natriuretic peptides [J].

Foote, RS ;

Pearlman, JD ;

Siegel, AH ;

Yeo, KTJ .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (10) :1980-1987

[9] EXERCISE-INDUCED ST DEPRESSION IN THE DIAGNOSIS OF CORONARY-ARTERY DISEASE - A META-ANALYSIS [J].

GIANROSSI, R ;

DETRANO, R ;

MULVIHILL, D ;

LEHMANN, K ;

DUBACH, P ;

COLOMBO, A ;

MCARTHUR, D ;

FROELICHER, V .

CIRCULATION, 1989, 80 (01) :87-98

[10] Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing [J].

Greenland, P ;

Gaziano, JM .

NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (05) :465-473

← 1 2 3 4 →