Premium
Myocardial ischaemia is associated with an elevated brain natriuretic pepide level even in the presence of left ventricular systolic dysfunction
Author(s) -
Adnan Nadir M.,
Dow Eleanor,
Davidson John,
Kennedy Norman,
Lang Chim C.,
Struthers Allan D.
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hft130
Subject(s) - medicine , cardiology , heart failure , perfusion , natriuretic peptide , troponin , ischemia , myocardial ischaemia , troponin t , myocardial perfusion scintigraphy , myocardial infarction , coronary angiography
Aims Plasma BNP and high‐sensitivity cardiac troponin‐T (hs‐TnT) are elevated by both ischaemia and LV systolic dysfunction (LVSD). As a result, it is unknown whether BNP and/or hs‐TnT could be useful biomarkers to identify ischaemia in the presence of LVSD. Methods and results Three separate patient populations were studied. Study A ( n = 500) involved consecutive patients undergoing clinically indicated myocardial perfusion scintigraphy, study B ( n = 100) included patients with vascular disease but no known cardiac disease, and study C ( n = 300) recruited primary prevention patients with controlled risk factors. Levels of BNP and hs‐TnT were measured prior to the stress testing to detect myocardial ischaemia. The prevalence of myocardial ischaemia was 28.2, 28, and 6.3% in study A, B, and C, respectively. For BNP, area under curve (AUC) values to identify ischaemia in the presence and absence of coincidental LVSD were: 0.73 vs. 0.63 (study A), 0.90 vs. 0.81 (study B), and 0.83 vs. 0.80 (study C). Equivalent figures for hs‐TnT were: 0.64 vs. 0.60 (study A), 0.75 vs. 0.68 (study B), and 0.53 vs. 0.68 (study C). BNP and hs‐cTnT, when combined together, performed better with an AUC of 0.75 vs. 0.65 (study A), 0.91 vs. 0.92 (study B), and 0.84 vs. 0.83 (study C). Conclusion In three separate populations a consistent finding is that BNP is increased further by myocardial ischaemia even in the presence of LVSD. A disproportionately high BNP for the degree of LVSD might be due to (unsuspected) ischaemia, and a disproportionately low BNP could be useful as a ‘rule out’ test for ischaemia even in the presence of LVSD.