title: Usefulness of N-terminal Pro-brain Natriuretic Peptide and Myocardial Perfusion in Asymptomatic Adults (from the Multi-Ethnic Study of Atherosclerosis).
abstract: This study sought to investigate the relation between myocardial perfusion and N-terminal pro-brain natriuretic peptide (NT-proBNP) in asymptomatic adults without overt coronary artery disease. NT-proBNP is a cardiac neurohormone secreted from the ventricles in response to ventricular volume expansion and pressure overload and may also be elevated in the setting of reduced myocardial perfusion. We hypothesized that reduced myocardial perfusion reserve (MPR) would be associated with elevated NT-proBNP in participants free of overt cardiovascular disease. MPR was measured by cardiac magnetic resonance, before and after adenosine infusion, in 184 MESA participants (mean age 60 ± 10.4, 58% white, 42% Hispanic, 44% women) without overt cardiovascular disease. MPR was modeled as hyperemic myocardial blood flow (MBF) adjusted for MBF at rest. A linear regression analysis, adjusted for demographics, established cardiovascular risk factors, left ventricular mass, coronary calcium score, body mass index, and medications, was used to determine the association between MPR and NT-proBNP. Participants with low hyperemic MBF were more likely to be older, male, diabetic, and have higher blood pressure and higher coronary artery calcium score. Mean hyperemic MBF was 3.04 ± 0.829 ml/min/g. MPR was inversely associated with NT-proBNP levels. In a fully adjusted model, every 1-SD decrement in MPR was associated with a 21% increment in NT-proBNP (p = 0.04). In conclusion, MPR is inversely associated with NT-proBNP level in this cross-sectional study of asymptomatic adults free of overt coronary artery disease, suggesting that higher NT-proBNP levels may reflect subclinical myocardial microvascular dysfunction.
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors: Adam
authors: A
authors: Mitchell
authors: Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: Jeffrey R
authors: JR
authors: Misialek
authors: Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: Aaron R
authors: AR
authors: Folsom
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors: Daniel
authors: D
authors: Duprez
authors: Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: Alvaro
authors: A
authors: Alonso
authors: Department of Radiology, Brigham and Woman's Hospital, Boston, Massachusetts.
authors: Michael
authors: M
authors: Jerosch-Herold
authors: Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: Otto A
authors: OA
authors: Sanchez
authors: Division of Cardiology, University of California Los Angeles, Los Angeles, California.
authors: Karol E
authors: KE
authors: Watson
authors: Division of Cardiology, University of California Los Angeles, Los Angeles, California.
authors: Tamer
authors: T
authors: Sallam
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: shkonety@umn.edu.
authors: Suma H
authors: SH
authors: Konety
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology; D003326:Coronary Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors; D012307:Risk Factors
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain