title: B-type natriuretic peptide levels predict extent and severity of coronary disease in non-ST elevation coronary syndromes and normal left ventricular systolic function.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) has been used recently as a biological marker in patients with coronary artery disease (CAD) with ST-elevation, as well as without ST-elevation. BNP is able to predict systolic dysfunction, adding new prognostic information to existing traditional markers. However is not known if there is a relation between the quantity of BNP levels and the severity of coronary artery disease.
  
  
  METHODS
  This study compared B-type natriuretic peptide (BNP) levels in patients with stable angina (SA) and acute coronary syndromes (ACS) without ST-elevation in relation to angiographic lesions using TIMI and Gensini Scores. We studied 282 patients with CAD without ST elevation and preserved systolic function. BNP samples were measured in all recruited patients within 24 hours of hospitalization.
  
  
  RESULTS
  BNP values were progressively increased in relation to the severity of diagnosis: SA (52.6±49.4 pg/mL ) UA (243.3±212 pg/mL) NSTE-ACS (421.7±334 pg/mL) (p<0.0001 and p<0.007 respectively). No statistically significant difference was observed between patients with SA and controls (21.2±6.8 pg/mL). The analysis of BNP levels in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1 or 2 vessel disease (1-86.2±46.3 pg/mL; 2-127±297 pg/mL; 3-295±318 pg/mL; 4-297±347 pg/mL p<0.001 and p<0.003). Evaluation of BNP using Gensini Score showed a strong relation between BNP and coronary disease extension (r=0.38 p<0.0001).This trend was maintained in all CAD groups (SA=r 0.54; UA r=0.36 NSTE-ACS r=0.28).
  
  
  CONCLUSIONS
  Circulating BNP levels appear elevated in ACS with diffuse coronary involvement, even in the absence of systolic dysfunction. BNP is also associated with multi-vessel disease and the extension of coronary disease.
authors.affiliation: Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy. palazzuoli2@unisi.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Maria
authors.initials: M
authors.lastname: Caputo
authors.forename: Massimo
authors.initials: M
authors.lastname: Fineschi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Quatrini
authors.forename: Anna
authors.initials: A
authors.lastname: Calabrò
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Campagna
authors.forename: Beatrice
authors.initials: B
authors.lastname: Franci
authors.forename: Stefanie
authors.initials: S
authors.lastname: Grothgar
authors.forename: Carlo
authors.initials: C
authors.lastname: Pierli
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000503:physiopathology; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000378:metabolism; D011379:Prognosis; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain