Delayed release of brain natriuretic peptide to identify myocardial ischaemia
Stephan Zürcher1,2, Ursina Honegger1,2, Max Wagener1,2
1Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Insights
Delayed cardiac biomarker sampling for exercise-induced myocardial ischemia showed no diagnostic benefit. B-type natriuretic peptide (BNP) levels were higher in patients with ischemia, but late sampling did not improve accuracy.
Area of Science:
- Cardiology
- Biomarker Research
- Diagnostic Imaging
Background:
- A prior pilot study suggested delayed cardiac biomarker release following exercise-induced myocardial ischemia.
- This indicated potential for later sampling (e.g., 4 hours post-exercise) for diagnostic purposes.
Purpose of the Study:
- To investigate if delayed sampling of B-type natriuretic peptide (BNP) improves diagnosis of myocardial ischemia.
- To evaluate the diagnostic accuracy of BNP levels at rest, peak stress, and 4 hours post-stress.
Main Methods:
- An observational study included 129 patients undergoing myocardial perfusion imaging for suspected coronary artery disease.
- BNP levels were measured at rest, peak stress, and 4 hours post-stress.
- Clinical judgment and imaging determined the presence of myocardial ischemia.
Main Results:
- Myocardial ischemia was present in 45% of patients.
- Patients with ischemia had significantly higher BNP levels at all measured time points (rest, peak, 4h).
- Diagnostic accuracy (AUC) was moderate and similar across all time points (0.64-0.66); the change in BNP did not add value.
Conclusions:
- Contrary to the hypothesis, myocardial ischemia did not result in differential delayed BNP release.
- Late sampling of BNP (4 hours post-stress) did not appear clinically useful for diagnosing myocardial ischemia.
Background:
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.
Materials And Methods:
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.
Results:
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 P = 0·007), BNP stress (125 vs. 77 pg/mL P = 0·02) and BNP 4 h (114 vs. 71 pg/mL P = 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.
Conclusion:
In contrast to our hypothesis, myocardial ischaemia did not lead to a differential delayed release of BNP. Late sampling did not seem clinically useful.
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