title: Baseline plasma N-terminal pro-B-type natriuretic peptide is associated with the extent of stress-induced myocardial ischemia during dobutamine stress echocardiography.
abstract: OBJECTIVE
  To determine the relationship between baseline plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the presence and extent of myocardial ischemia during dobutamine stress echocardiography (DSE).
  
  
  METHODS
  NT-proBNP was measured in 170 consecutive patients prior to DSE. Rest wall motion abnormalities (RWMAs) and new wall motion abnormalities (NWMAs) were scored using a 5-point, 17-segment model. Kruskal-Wallis tests were applied to study differences in NT-proBNP levels between patients with normal DSE, RWMAs but no NWMAs, and NWMAs, and (in patients with NWMAs) between those with 1-2, 3-4 and >4 ischemic segments. Univariate and multivariate regression analyses were used to determine the value of NT-proBNP in predicting NWMAs.
  
  
  RESULTS
  The median NT-proBNP level was 110 ng/l (interquartile range: 42-389 ng/l). Median NT-proBNP was 59, 321 and 440 ng/l in patients with normal DSE, with RWMAs but no NWMAs, and with NWMAs, respectively (P<0001). Among patients with NWMAs, median NT-proBNP was associated with the number of ischemic segments: 364, 710 and 2376 ng/l in patients with 1-2, 3-4 and >4 ischemic segments, respectively (P<0.001). Elevated NT-proBNP levels were significantly associated with NWMAs (odds ratio per 100 ng/l increase: 1.14, 95% confidence interval: 1.1-1.2) in a multivariate analysis of clinical baseline variables and RWMAs.
  
  
  CONCLUSIONS
  Elevated baseline levels of NT-proBNP are associated with the presence and extent of myocardial ischemia during DSE, independent of the presence of RWMAs.
authors.affiliation: Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Robert
authors.initials: R
authors.lastname: de Jonge
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Jan
authors.initials: J
authors.lastname: Lindemans
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain