title: Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia.
abstract: OBJECTIVE
  The aim of this study was to determine the effect of transient myocardial ischemia on circulating natriuretic peptide levels.
  
  
  BACKGROUND
  Natriuretic peptides are released by the heart in response to wall stress. We hypothesized that transient myocardial ischemia would cause acute changes in circulating natriuretic peptide levels.
  
  
  METHODS
  B-type natriuretic peptide (BNP), N-terminal fragment of BNP pro-hormone (NT-pro-BNP), and N-terminal fragment of atrial natriuretic peptide pro-hormone (NT-pro-ANP) levels were measured in 112 patients before, immediately after, and 4 h after exercise testing with nuclear perfusion imaging.
  
  
  RESULTS
  Baseline levels of BNP were associated with the subsequent severity of provoked ischemia, with median levels of 43, 62, and 101 pg/ml in patients with none, mild-to-moderate, and severe inducible ischemia, respectively (p = 0.03). Immediately after exercise, the median increase in BNP was 14.2 pg/ml in patients with mild-to-moderate ischemia (p = 0.0005) and 23.7 pg/ml in those with severe ischemia (p = 0.017). In contrast, BNP levels only rose by 2.3 pg/ml in those who did not develop ischemia (p = 0.31). A similar relationship was seen between baseline NT-pro-BNP levels and inducible ischemia, but the changes in response to ischemia were less pronounced. NT-pro-ANP levels rose with exercise in both ischemic and non-ischemic patients. When added to traditional clinical predictors of ischemia, a post-stress test BNP >or=80 pg/ml remained a strong and independent predictor of inducible myocardial ischemia (odds ratio 3.0, p = 0.025).
  
  
  CONCLUSIONS
  Transient myocardial ischemia was associated with an immediate rise in circulating BNP levels, and the magnitude of rise was proportional to the severity of ischemia. These findings demonstrate an important link between the severity of an acute ischemic insult and the circulating levels of BNP.
authors.affiliation: TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. msabatine@partners.org <msabatine@partners.org>
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sabatine
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Omland
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.forename: Milenko
authors.initials: M
authors.lastname: Tanasijevic
authors.forename: Christian
authors.initials: C
authors.lastname: Hall
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: McCabe
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D009320:Atrial Natriuretic Factor / Q000097:blood; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: C099254:N-terminal proatrial natriuretic peptide; D045265:Natriuretic Peptides; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor