N-terminal pro-B-type natriuretic Peptide predicts significant coronary artery lesion in the unstable angina patients with normal electrocardiogram, echocardiogram, and cardiac enzymes.
BACKGROUND
Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are not specific for ventricular dysfunction and other cardiac processes, such as myocardial ischemia, may also cause elevation of these markers.


RESULTS
To determine whether elevation of NT-proBNP without elevation of cardiac specific markers can predict coronary artery disease (CAD), the serum level of NT-proBNP was measured in 161 patients with unstable angina (61.0+/-8.1 years, male 54.0%) with normal ventricular function (left ventricular ejection fraction >55% and no regional wall motion abnormality by echocardiography) and normal troponin I level (<0.05 ng/ml). In these patients, levels of C-reactive protein and myoglobin were normal and none had Q wave on electrocardiographic (ECG). The NT-proBNP level was higher in patients with CAD (n=74) than in patients without CAD (n=87) (173.1+/-231.6 vs 68.1+/-62.5 pg/ml, p<0.001). At the standard cut-off point of >200 pg/ml, elevated NT-proBNP level shows high probability of CAD (odds ratio, 10.1; 95% confidence interval, 2.6-38.7, p=0.001). The NT-proBNP level positively correlated with the extent of CAD (r=0.329, p=0.001). In multivariate analysis, the NT-proBNP was an independent predictor of CAD.


CONCLUSIONS
These results suggested that NT-proBNP is a useful screening test for CAD in the unstable angina patients with normal ECG, echocardiogram and cardiac enzyme levels.
Hong
Seo Na
SN
Department of Cardiovascular Medicine, The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Science, Gwangju, South Korea.
Yoon
Nam Sik
NS
Ahn
Youngkeun
Y
Lim
Sang Yub
SY
Kim
Yong Sook
YS
Yun
Kyung Ho
KH
Kang
Dong Koo
DK
Lee
Sang Hyun
SH
Lee
Yeon Sang
YS
Kim
Kye Hun
KH
Son
Il Seok
IS
Hong
Young Joon
YJ
Park
Hyung Wook
HW
Kim
Ju Han
JH
Jeong
Myung Ho
MH
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000201:enzymology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain