N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris.
BACKGROUND
B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are elevated in patients with acute coronary syndromes and are closely linked to prognosis. Because there is only a small amount of data available concerning NT-proBNP in patients with stable angina pectoris, we aimed to determine whether NT-proBNP is of additional diagnostic value in these patients.


RESULTS
Ninety-four patients with stable angina pectoris were prospectively included. All patients underwent exercise testing and coronary angiography, and 91 patients received thallium-201 single-photon emission computed tomography myocardial scintigraphy. NT-proBNP was analyzed at rest and after exercise testing. NT-proBNP was elevated in patients with inducible myocardial ischemia shown by single-photon emission computed tomography (396 +/- 80 pg/mL vs 160 +/- 101 pg/mL; P <.01) closely linked to the extent of coronary artery disease (CAD) (no CAD, 148 +/- 29 pg/mL; 1- or 2-vessel disease, 269 +/- 50 pg/mL; 3-vessel disease 624 +/- 186 pg/mL; P <.01). In a multivariate analysis, NT-proBNP was an independent predictor for CAD. The area under the curve of the receiver operating characteristic curve was 0.72 for NT-proBNP to predict CAD. Using an optimized cut off level of 214 pg/mL, CAD can be predicted with high accuracy. The total test efficiency of exercise testing can be improved from 1.46 to 1.52 when combined with NT-proBNP measurement.


CONCLUSIONS
NT-proBNP is elevated in patients with stable angina pectoris and has a close correlation to disease severity. Combining the measurement of NT-proBNP with exercise testing, the test accuracy for predicting severe CAD can be improved. Our data show an incremental value of NT-proBNP in the diagnostic process of stable angina pectoris.
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. M.Weber@kerckhoff-klinik.de
Michael
M
Weber
Thorsten
T
Dill
Roman
R
Arnold
Matthias
M
Rau
Okan
O
Ekinci
Klaus D
KD
Müller
Alexander
A
Berkovitsch
Veselin
V
Mitrovic
Christian
C
Hamm
D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000145:classification; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis*; D005080:Exercise Test; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D015415:Biomarkers; D013794:Thallium Radioisotopes; D020097:Natriuretic Peptide, Brain