title: Exertional changes in circulating cardiac natriuretic peptides in patients with suggested coronary artery disease.
abstract: 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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Horng H
authors.initials: HH
authors.lastname: Chen
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain