Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000103681.04726.9C
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(Circulation. 2003;108:2987.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease
Data From the Heart and Soul Study
From the Department of Medicine (K.B.D., M.A., N.B.S., B.M., M.A.W.), Division of Cardiology (M.A., N.B.S., B.M.), and Department of Epidemiology and Biostatistics (M.A.W.), University of California, San Francisco; the VA Medical Center (M.A., N.B.S., B.M., M.A.W.), San Francisco; and University of California, San Francisco.
Correspondence to Mary A. Whooley, MD, 4150 Clement St (111A1), San Francisco, CA 94121. E-mail whooley{at}itsa.ucsf.edu
Received June 10, 2003; de novo received August 12, 2003; revision received September 11, 2003; accepted September 12, 2003.
Background— In patients with symptoms of heart failure, elevations in B-type natriuretic peptide (BNP) accurately identify ventricular dysfunction. However, BNP levels are not specific for ventricular dysfunction in patients who do not have overt symptoms of heart failure, suggesting that other cardiac processes such as myocardial ischemia may also cause elevations in BNP.
Methods and Results— To determine whether BNP elevations are associated with myocardial ischemia, we measured plasma BNP levels before performing exercise treadmill testing with stress echocardiography in outpatients with stable coronary disease. Of the 355 participants, 113 (32%) had inducible ischemia. Compared with participants in the lowest BNP quartile (0 to 16.4 pg/mL), those in the highest quartile of BNP (
105 pg/mL) had double the risk of inducible ischemia (adjusted relative risk, 2.0; 95% CI, 1.2 to 2.6; P=0.008). The relation between elevated BNP levels and inducible ischemia was especially evident in the 206 participants who had a history of myocardial infarction (adjusted relative risk, 2.6; 95% CI, 1.5 to 3.7, P=0.002) and was absent in those without a history of myocardial infarction (adjusted relative risk, 1.0; 95% CI, 0.3 to 2.2; P=0.9). This association between BNP levels and inducible ischemia remained strong after adjustment for measures of systolic and diastolic dysfunction.
Conclusions— Elevated levels of BNP are independently associated with inducible ischemia among outpatients with stable coronary disease, particularly among those with a history of myocardial infarction. The observed association between BNP levels and ischemia may explain why tests for BNP are not specific for ventricular dysfunction among patients with coronary disease.
Key Words: natriuretic peptides • ischemia • myocardial infarction • heart failure • coronary disease
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