Delayed release of brain natriuretic peptide to identify myocardial ischaemia. (7th October 2015)

• Record Type: Journal Article
• Authors: Zürcher, Stephan; Honegger, Ursina; Wagener, Max; Lee, Gino; Stallone, Fabio; Marxer, Tanja; Puelacher, Christian; Schumacher, Carmela; Sou, Seoung Mann; Twerenbold, Raphael; Reichlin, Tobias; Hochgruber, Thomas; Tanglay, Yunus; Freese, Michael; Wild, Damian; Rentsch, Katharina; Osswald, Stefan; Zellweger, Michael; Mueller, Christian
• Is Part Of: European journal of clinical investigation. Volume 45:Number 11(2015:Nov.)
• Page Start: 1175
• Page End: 1183
• Publication Date: 2015-10-07
• Subjects: Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12535
• Languages: English
• ISSNs: 0014-2972

Abstract

<abstract abstract-type="main" id="eci12535-abs-0001"> <title>Abstract</title> <sec id="eci12535-sec-0001" sec-type="section"> <title>Background</title> <p>A recent pilot study suggested that exercise‐induced myocardial ischaemia may lead to a delayed release of cardiac biomarkers, so that later sampling, for example, at 4 h after exercise could be used for diagnostic purpose.</p> </sec> <sec id="eci12535-sec-0002" sec-type="section"> <title>Materials and methods</title> <p>In an observational study, we enrolled 129 consecutive patients referred for evaluation of a suspected coronary artery disease by rest/stress myocardial perfusion single‐photon emission computed tomography. The treating cardiologist used all available clinical information to quantify clinical judgment regarding the presence of myocardial ischaemia using a visual analogue scale twice: prior and after stress testing. BNP levels were determined in a blinded fashion at rest, at peak stress and 4 h after peak stress. The presence of myocardial ischaemia was adjudicated based on perfusion single‐photon emission computed tomography and coronary angiography findings by an independent cardiologist.</p> </sec> <sec id="eci12535-sec-0003" sec-type="section"> <title>Results</title> <p>Myocardial ischaemia was detected in 58 patients (45%). Patients with myocardial ischaemia had significantly higher BNP levels at all times, compared to patients without ischaemia: BNP rest (99 vs. 61 pg/mL <italic>P</italic> = 0·007), BNP stress (125 vs. 77 pg/mL <italic>P</italic> = 0·02) and BNP 4 h (114 vs. 71 pg/mL <italic>P</italic> = 0·018). Diagnostic accuracy as quantified by the area under the receiver operating characteristics curve (AUC) was moderate for all time points (AUC 0·64–0·66). The change in BNP between rest and 4 h did not provide added value, neither to the baseline BNP level nor to clinical judgment.</p> </sec> <sec id="eci12535-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In contrast to our hypothesis, myocardial ischaemia did not lead to a differential delayed release of BNP. Late sampling did not seem clinically useful.</p> </sec> </abstract>