title: N-terminal pro-B-type natriuretic peptide and inducible ischemia in the Heart and Soul Study.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) is predictive of inducible ischemia in patients with coronary heart disease (CHD). Whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) has a comparable strength of association with ischemia is uncertain.
  
  
  OBJECTIVE
  Resting NT-proBNP levels are associated with inducible ischemia in patients with stable CHD.
  
  
  METHODS
  We performed a cross-sectional study of 901 outpatients with stable CHD. NT-proBNP was measured in all patients prior to exercise treadmill testing and stress echocardiography. In addition, plasma BNP was measured in a subset of 355 participants. Logistic regression was used to examine the association of NT-proBNP and BNP quartiles with inducible ischemia.
  
  
  RESULTS
  Inducible ischemia was found in 216 (24%) patients. The proportion with inducible ischemia ranged from 42% (95/225) in the highest quartile of NT-proBNP levels (>410 pg/ml) to 9% (21/226) in the lowest quartile (0-72 pg/ml). The highest quartile had a 7-fold greater odds of inducible ischemia than the lowest quartile (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 4.2-12; P < 0.0001). This association remained robust after adjustment for traditional cardiovascular risk factors, left ventricular ejection fraction, and diastolic dysfunction (OR: 3.6, 95% CI: 1.4-9.1; P = 0.009). In the subgroup with measurements of both NT-proBNP and BNP, both natriuretic peptides were predictive of ischemia. The multivariable-adjusted c-statistics for inducible ischemia were 0.71 for NT-proBNP and 0.62 for BNP (entered as continuous variables).
  
  
  CONCLUSIONS
  Resting NT-proBNP levels are independently associated with inducible ischemia in outpatients with stable CHD. Baseline elevations of natriuretic peptide may indicate subclinical inducible ischemia in high risk patients with CHD.
authors.affiliation: Division of Cardiology, Columbia University, New York Presbyterian Hospital, New York, New York, USA.
authors.forename: Harsimran S
authors.initials: HS
authors.lastname: Singh
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Sadia
authors.initials: S
authors.lastname: Ali
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D003430:Cross-Sectional Studies; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010045:Outpatients; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
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