Exertional changes in circulating cardiac natriuretic peptides in patients with suggested coronary artery disease.
BACKGROUND
We measured plasma brain natriuretic peptide (BNP) and N-terminal atrial natriuretic peptide (ANP) levels before and after exercise stress testing and correlated results with echocardiographic evidence of ischemia.


METHODS
Sixty patients with left ventricular ejection fraction greater than 50% referred for clinically indicated exercise echocardiogram were studied. Peptides were measured at rest and 5 minutes after symptom-limited exercise.


RESULTS
Echocardiography was positive for ischemia in 19 (32%). With exercise, ANP level increased in all 60 patients (median at rest 2501 [799-6440]-3167 [977-8563] pg/mL after exercise [P < .0001]). BNP increased in 54 patients (90%) (19 [<3.9-213]-30 [<3.9-318] pg/mL [P < .0001]). In multivariable analysis, both exercise BNP level and exertional change in BNP were closely associated with rest BNP (P < .0001); both were also significantly associated with change in wall-motion score index and workload (P = .001 and P = .01, respectively). Exercise ANP was strongly related to rest level (P < .0001); change in ANP was related to workload (P < .0001).


CONCLUSIONS
In patients with suggested coronary artery disease, exertional levels of BNP are influenced not only by development of stress-induced ischemia, but also by resting levels.
Bergeron
Sébastien
S
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Møller
Jacob E
JE
Bailey
Kent R
KR
Chen
Horng H
HH
Burnett
John C
JC
Pellikka
Patricia A
PA
D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006325:Heart Atria / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D005082:Physical Exertion; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging* / Q000209:etiology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain