title: Use of B-type natriuretic peptide in the detection of myocardial ischemia.
abstract: BACKGROUND
  Exercise electrocardiography (ECG) has high specificity but limited sensitivity for the detection of myocardial ischemia. The aim of this study was to determine whether measurement of B-type natriuretic peptide (BNP) can improve the diagnostic accuracy of exercise ECG.
  
  
  METHODS
  A total of 256 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography were enrolled. Levels of BNP were determined before and 1 minute after maximal exercise.
  
  
  RESULTS
  Inducible myocardial ischemia on perfusion images was detected in 127 patients (49.6%). Median BNP levels at rest and after peak exercise were higher in patients with than without inducible ischemia (71 pg/mL vs 38 pg/mL, P < .001; and 88 vs 52 pg/mL, P < .001, respectively). Compared with patients in the lowest peak exercise BNP quartile, those in the highest quartile of peak exercise BNP had more than 3 times the risk of inducible ischemia (adjusted relative risk 3.3, 95% CI 1.3-8.6, P = .015). Using 110 pg/mL as a cutoff, the combination of exercise ECG and peak exercise BNP level distinguished between ischemic and nonischemic patients more accurately than the exercise ECG alone (67% vs 60%, P = .024). Although the increase in accuracy was similar for the combination of exercise ECG with baseline BNP or DeltaBNP, overall, peak exercise BNP seemed to be the preferred measurement.
  
  
  CONCLUSIONS
  B-type natriuretic peptide levels are associated with inducible myocardial ischemia. The use of BNP levels improves the diagnostic accuracy of exercise ECG.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Staub
authors.forename: Charly
authors.initials: C
authors.lastname: Nusbaumer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zellweger
authors.forename: Nils
authors.initials: N
authors.lastname: Jonas
authors.forename: Damian
authors.initials: D
authors.lastname: Wild
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: Jan
authors.initials: J
authors.lastname: Mueller-Brand
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015203:Reproducibility of Results
chemical_list: D020097:Natriuretic Peptide, Brain