title: NT-proBNP and circulating inflammation markers in prediction of a normal myocardial scintigraphy in patients with symptoms of coronary artery disease.
abstract: BACKGROUND
  Myocardial perfusion imaging (MPI) can detect myocardial perfusion abnormalities but many examinations are without pathological findings. This study examines whether circulating biomarkers can be used as screening modality prior to MPI.
  
  
  RESULTS
  243 patients with an intermediate risk of CAD or with known CAD with renewed suspicion of ischemia were referred to MPI. Blood samples were analyzed for N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), YKL-40, IL-6, matrix metalloproteinase 9 (MMP-9) and high sensitive C-reactive protein (hsCRP). Patients with myocardial perfusion defects had elevated levels of NT-proBNP (p<0.0001), YKL-40 (p = 0.03) and IL-6 (p = 0.03) but not of hsCRP (p = 0.58) nor of MMP-9 (p = 0.14). The NT-proBNP increase was observed in both genders (p<0.0001), whereas YKL-40 (p = 0.005) and IL-6 (p = 0.02) were elevated only in men. A NT-proBNP cut off-concentration at 25 ng/l predicted a normal MPI with a negative predictive value >95% regardless of existing CAD.
  
  
  CONCLUSIONS
  20-25% of patients suspected of CAD could have been spared a MPI by using a NT-proBNP cut-off concentration at 25 ng/l with a negative predictive value >95%. NT-proBNP has the potential use of being a screening marker of CAD before referral of the patient to MPI.
authors.affiliation: Department of Internal Medicine, Center of Endocrinology and Metabolism, Copenhagen University Hospital Herlev, Herlev, Denmark. cnr@dadlnet.dk
authors.forename: Camilla Noelle
authors.initials: CN
authors.lastname: Rathcke
authors.forename: Erik
authors.initials: E
authors.lastname: Kjøller
authors.forename: Niels
authors.initials: N
authors.lastname: Fogh-Andersen
authors.forename: Bo
authors.initials: B
authors.lastname: Zerahn
authors.forename: Henrik
authors.initials: H
authors.lastname: Vestergaard
mesh_terms: D054392:Adipokines; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D000071451:Chitinase-3-Like Protein 1; D003324:Coronary Artery Disease / Q000473:pathology*; D005260:Female; D006023:Glycoproteins / Q000096:biosynthesis; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000096:biosynthesis; D007511:Ischemia; D037102:Lectins / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011237:Predictive Value of Tests; D012306:Risk; D012737:Sex Factors
chemical_list: D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D006023:Glycoproteins; D015850:Interleukin-6; D037102:Lectins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain