Association of plasma atrial natriuretic peptide, N-terminal proatrial natriuretic peptide, and brain natriuretic peptide levels with coronary artery stenosis in patients with normal left ventricular systolic function.
OBJECTIVE
To examine whether coronary artery stenosis affects plasma levels of atrial natriuretic peptide (ANP), N-terminal proatrial natriuretic peptide (proANP), and brain natriuretic peptide (BNP) in patients with normal left ventricular systolic function.


METHODS
We studied 104 consecutive patients with normal left ventricular function and suspected coronary artery stenosis. Plasma natriuretic peptide levels were measured by immunoradiometric assays.


RESULTS
Plasma levels of ANP, N-terminal proANP, and BNP were higher in patients with (n = 65) than in those without (n = 39) coronary artery stenosis, whereas hemodynamic variables were similar. Patients who had coronary artery stenosis with only distal lesions (n = 36) had higher levels of all three natriuretic peptides than did patients with no coronary artery stenosis. N-terminal proANP levels were significantly higher in patients who had coronary artery stenosis with proximal lesions (n = 29) than in patients who had coronary artery stenosis with only distal lesions and those with no coronary artery stenosis. Multiple logistic regression analysis revealed that N-terminal proANP, but not ANP or BNP, was independently associated with coronary artery stenosis after adjusting for clinical and demographic variables (odds ratio per 100 fmol/mL increase = 1.9; 95% confidence interval: 1.9 to 2.6; P = 0.01). However, the sensitivity, specificity, and positive and negative predictive values of each peptide were not sufficiently high to be used for prediction.


CONCLUSIONS
N-terminal proANP may be associated with clinically important coronary artery stenosis in patients with normal left ventricular systolic function, but its clinical usefulness may be limited.
Nishikimi
Toshio
T
Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Mibu, Tochigi, Japan. nishikim@dokkyomed.ac.jp
Mori
Yosuke
Y
Ishimura
Kimihiko
K
Tadokoro
Kazuyoshi
K
Yagi
Hiroshi
H
Yabe
Akihisa
A
Horinaka
Shigeo
S
Matsuoka
Hiroaki
H
D009320:Atrial Natriuretic Factor / Q000097:blood*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D023921:Coronary Stenosis / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D016277:Ventricular Function, Left
D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor