Meta-analysis of B-type natriuretic peptide's ability to identify stress induced myocardial ischemia

Studies in victims of sudden cardiac death and those surviving a cardiac arrest have confirmed that extent of coronary artery disease is similar in those with and without angina, suggesting that it is the presence of myocardial ischemia rather than associated symptoms that determine the prognosis. Experimental models show that hypoxic myocardial tissue results in production of extra B-type natriuretic peptide (BNP), suggesting that BNP could potentially serve as a biomarker of myocardial ischemia. We performed a meta-analysis of the studies that link BNP to inducible myocardial ischemia as indicated by noninvasive stress tests. Values of true positive, false positive, true negative, and false negative were calculated from the reported sensitivity, specificity, disease prevalence, and total number of patients studied. Sixteen studies reporting data on 2,784 patients across 14 study populations were included in the final analysis. Mean age of participants was 55 to 69 years and 55% to 90% were men. Pooled sensitivity and specificity of BNP for detection of stress-induced myocardial ischemia were 71% (95% confidence interval [CI] 68 to 74) and 52% (95% CI 52 to 54), respectively. Pooled diagnostic odds ratio was 3.5 (95% CI 2.46 to 5.04) and summary receiver operating characteristic curve revealed an area under the curve of 0.71 ± 0.02 (mean ± SE). In conclusion, this meta-analysis suggests that an increased BNP level can identify inducible ischemia as detected by standard noninvasive stress tests. This raises the possibility of a whole new role for BNP in the diagnosis and management of myocardial ischemia.