title: Early brain natriuretic peptide increase reflects acute myocardial ischemia in patients with ongoing chest pain.
abstract: BACKGROUND
  Plasma brain natriuretic peptide levels increase during acute ischemic events. In this study we tested the diagnostic performance of brain natriuretic peptide measurements in the detection of acute myocardial ischemia.
  
  
  METHODS
  Blood brain natriuretic peptide was measured in 101 patients with ongoing chest pain but no heart failure or an ST-segment elevation myocardial infarction on arrival at the emergency department (baseline) and at 2 and 6 h later. After diagnostic testing and 1-month follow-up for ischemia, patients were classified as either ischemic or non-ischemic.
  
  
  RESULTS
  In the ischemic group median (25th, 75th percentiles) brain natriuretic peptide values (pg/ml) were 122 (20, 349) at baseline, 116 (36, 347) at 2 h, increasing to 148 (52, 428) at 6 h (p<0.001 vs. baseline). Non-ischemic patients had 12 (5, 32) at baseline, 9 (6, 30) at 2 h, and 13 (5, 29) at 6 h (p<0.001 vs. corresponding values of the ischemic group). Receiver operator characteristic curves were constructed for brain natriuretic peptide values at baseline 2 and 6 h and for the increase of peptide levels from baseline to 6 h. All areas under curve indicated a significant diagnostic ability for the detection of ischemia. The 6-h measurement had better diagnostic performance than baseline and 2-h measurements. The subgroup of ischemic patients without myocardial necrosis also had higher brain natriuretic peptide values and could thus be discriminated from non-ischemic subjects.
  
  
  CONCLUSIONS
  Brain natriuretic peptide values may detect acute myocardial ischemia in patients with ongoing chest pain but without ST-segment elevation, and distinguish ischemic patients from those with pain of non-ischemic origin.
authors.affiliation: Cardiology Department, Agia Olga General Hospital, Athens, Greece. nikosnik@otenet.gr
authors.forename: Nikolaos I
authors.initials: NI
authors.lastname: Nikolaou
authors.forename: Zenon S
authors.initials: ZS
authors.lastname: Kyriakides
authors.forename: Elias P
authors.initials: EP
authors.lastname: Tsaglis
authors.forename: Dionysios G
authors.initials: DG
authors.lastname: Antonatos
authors.forename: Eustathios C
authors.initials: EC
authors.lastname: Kartsagoulis
authors.forename: Dimitrios L
authors.initials: DL
authors.lastname: Tsigas
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D020097:Natriuretic Peptide, Brain