title: Use of changes in B-type natriuretic peptides to detect ischemia in selected patients.
abstract: BACKGROUND
  There is accumulating evidence that transient exercise-induced ischemia triggers the release of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The aim of this study was to either confirm or refute a previous investigation suggesting that myocardial ischemia can reliably be detected by exercise-induced changes in BNP or NT-proBNP levels in selected patients.
  
  
  METHODS
  A total of 139 consecutive patients with normal left ventricular function and normal resting BNP and NT-proBNP levels referred for rest/stress myocardial perfusion single-photon emission computed tomography (SPECT) were analyzed. Levels of BNP and NT-proBNP were determined before and immediately after symptom-limited bicycle ergometry.
  
  
  RESULTS
  Inducible myocardial ischemia on perfusion images was detected in 46 patients (33%). Median exercise-induced increases in BNP (DeltaBNP) and NT-proBNP (DeltaNT-proBNP) were similar in patients with and without inducible ischemia (DeltaBNP 12.7 pg/ml vs. 9.4 pg/ml, p=0.109; DeltaNT-proBNP 7 pg/ml vs. 6 pg/ml, p=0.309). The area under the receiver operating characteristic curve for the ability to detect myocardial ischemia was 0.583 (95% CI, 0.479-0.688) for DeltaBNP, and 0.553 (95% CI, 0.450-0.656) for DeltaNT-proBNP.
  
  
  CONCLUSIONS
  Exercise-induced changes in BNP and NT-proBNP do not reliably detect myocardial ischemia in selected patients.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Switzerland. staubd@uhbs.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Staub
authors.forename: Daniel
authors.initials: D
authors.lastname: Jauslin
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Anne
authors.initials: A
authors.lastname: Taegtmeyer
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zellweger
authors.forename: Jan
authors.initials: J
authors.lastname: Mueller-Brand
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis / Q000097:blood*; D010446:Peptide Fragments / Q000096:biosynthesis / Q000097:blood; D011498:Protein Precursors / Q000096:biosynthesis / Q000097:blood; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain