title: Incremental value of B-type natriuretic peptide for detection and risk reclassification of obstructive coronary artery disease on computed tomography angiography.
abstract: B-type natriuretic peptide (BNP) is well known to increase as a result of left ventricular systolic dysfunction and is a useful diagnostic marker for heart failure. The purpose of this study was to assess the incremental value of BNP for predicting obstructive coronary artery disease (CAD) on computed tomography angiography (CTA) in patients with suspected CAD.
  
  
  
  This was an observational analysis of patients with stable CAD undergoing CTA in our institution between April 2008 and June 2014. Consecutive 947 patients with suspected CAD who underwent 64-slice CTA were enrolled. Obstructive CAD was defined as more than 50% luminal narrowing. We divided the patients into 2 groups according to median BNP value (20.3pg/ml). Duke clinical score for obstructive CAD was calculated for each patient.
  
  
  
  Obstructive CAD was found in 273 (28.0%) patients. Median follow-up period was 37 months (interquartile range 21-55 months). Kaplan-Meier curves showed that BNP above median was significantly associated with major adverse cardiac events (p=0.001). In multivariable logistic analysis, patients with BNP above median were associated with the presence of obstructive CAD, as compared with BNP below median [odds ratio, 2.55; 95% confidence interval (CI), 1.79-3.63; p<0.001]. Analyzing the incremental value of the Duke clinical score and BNP, the predictive value of the Duke clinical score [area under the curve (AUC), 0.714] could be increased by BNP (AUC 0.745 for the combined model; p<0.001). Addition of BNP to a model containing the Duke clinical score resulted in net reclassification improvement index of 0.14 (95% CI: 0.053-0.205, p<0.001).
  
  
  
  BNP might provide an incremental improvement in the detection of obstructive CAD on CTA when combined with a conventional cardiovascular risk score.
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kawabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: Department of Cardiology, Moriya General Hospital, Moriya, Japan.
authors.forename: Masae
authors.initials: M
authors.lastname: Endo
authors.affiliation: Department of Cardiology, Moriya General Hospital, Moriya, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yoshida
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000097:blood* / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Computed tomography angiography; Coronary artery disease