Use of pro-atrial natriuretic peptide in the detection of myocardial ischaemia.
BACKGROUND
Because of its unique storage and release mechanisms allowing a very rapid response to haemodynamic changes, pro-atrial natriuretic peptide (proANP) may be a helpful cardiac marker in the detection of myocardial ischaemia.


METHODS
A total of 260 consecutive patients with suspected myocardial ischaemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography (SPECT) were enrolled. Levels of plasma proANP were determined before and 1 min after maximal exercise.


RESULTS
Baseline proANP and peak exercise proANP were significantly higher in patients with myocardial ischaemia as compared to those without ischaemia (median, 82 [IQR, 57-112] vs. 67 [IQR, 50-106] pmol L(-1), P = 0.007; and 89 [IQR, 65-121] vs. 78 [IQR, 57-116] pmol L(-1), P = 0.033). The area under the ROC curve for baseline proANP was 0.597 (95% CI, 0.527-0.667), as compared to 0.577 (95% CI, 0.507-0.648) for peak exercise proANP. Exercise-induced changes in proANP were similar in patients with and without myocardial ischaemia, and showed no correlation with the extent of myocardial ischaemia.


CONCLUSIONS
Baseline proANP and peak exercise proANP are significantly higher in patients with myocardial ischaemia. However, because of considerable overlap in proANP levels between patients with and without myocardial ischaemia, neither measurement seems helpful in the detection of myocardial ischaemia in clinical practice.
Bocek
T
T
Department of Internal Medicine, Medical Division A, University Hospital Basel, Switzerland.
Morgenthaler
N G
NG
Staub
D
D
Nusbaumer
C
C
Christ
A
A
Zellweger
M J
MJ
Mueller-Brand
J
J
Mueller
B
B
Perruchoud
A P
AP
Mueller
C
C
D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon
D015415:Biomarkers; D009320:Atrial Natriuretic Factor