Related Experiment Video
Updated: Sep 22, 2025
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Exercise-induced change in circulating NT-proBNP could not distinguish between patients with and without coronary
Joanna Cwikiel1,2,3, Morten W Fagerland4, Kristian Wachtell5
1Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.
Insights
Resting NT-proBNP levels were higher in patients with coronary artery disease (CAD). Combining resting NT-proBNP with exercise stress tests improved CAD prediction compared to exercise tests alone.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Accuracy
Background:
- Exercise stress tests have moderate accuracy for diagnosing coronary artery disease (CAD).
- Cardiac biomarkers could enhance the diagnostic precision of exercise stress testing.
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potential biomarker for cardiovascular conditions.
Purpose of the Study:
- To investigate circulating NT-proBNP levels before and during exercise stress tests in patients with and without CAD.
- To determine if NT-proBNP provides additive diagnostic value to exercise stress tests for CAD.
- To compare NT-proBNP levels in patients with and without angiographically verified CAD.
Main Methods:
- Recruited 297 patients with stable CAD symptoms undergoing maximal bicycle ergometer stress tests.
- Collected venous blood samples at rest and within 5 minutes post-exercise for NT-proBNP measurement.
- Performed coronary angiography to define significant CAD (≥75% stenosis).
Main Results:
- Significant CAD was identified in 111 (37%) participants.
- Resting NT-proBNP levels were significantly higher in patients with CAD (74.18 ng/L) versus without CAD (56.03 ng/L).
- Exercise-induced NT-proBNP increase did not differ significantly between groups; however, combining resting NT-proBNP with a positive stress test improved CAD prediction (AUC=0.68 vs 0.64).
Conclusions:
- Exercise-induced changes in NT-proBNP do not differentiate between patients with or without CAD.
- Resting NT-proBNP levels are significantly elevated in patients with CAD.
- Resting NT-proBNP may offer additive value when combined with exercise stress testing for CAD diagnosis.
Abstract:
Objective. In patients with chest pain, exercise stress test has a moderate accuracy for coronary artery disease (CAD). Adding a reliable cardiac biomarker to the exercise test could potentially improve the precision of the test. We investigated circulating NT-proBNP levels before and during exercise stress test in patients with and without angiographically verified CAD. We hypothesized that NT-proBNP would give an additive diagnostic value to the exercise stress test. Methods. In patients presenting with symptoms of stable CAD, venous blood samples were taken at rest and within 5 min of termination of a maximal stress test on a bicycle ergometer. All study participants underwent coronary angiography. Significant CAD was defined as ≥75% stenosis in one or more segments of the coronary arteries. Results. Of the 297 participants, significant CAD was found in 111 (37%) patients. Resting levels of NT-proBNP were significantly higher in patients with CAD compared with patients without CAD (74.18 vs. 56.03 ng/L), p = .005. During exercise, NT-proBNP levels increased in the total population (p < .001). The rise was, however, not significantly different between the two groups (8.24 vs. 8.51 ng/L), p = .700. Combining resting NT-proBNP with positive exercise stress test was superior to exercise test alone in predicting CAD, AUC = 0.68 vs. 0.64. Conclusion. Exercise-induced change in circulating NT-proBNP could not distinguish between patients with or without CAD. However, resting levels of NT-proBNP were significantly higher in patients with CAD than those without CAD.
More Related Videos
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:28Imaging Studies for Cardiovascular System V: CT