B-type natriuretic peptide and clinical judgment in the detection of exercise-induced myocardial ischemia
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B-type natriuretic peptide and clinical judgment in the detection of exercise-induced myocardial ischemia. / Lee, Gino; Sou, Seoung Mann; Twerenbold, Raphael; Reichlin, Tobias; Oshima, Shino; Hochgruber, Thomas; Zürcher, Stephan; Matter, Deborah; Tanglay, Yunus; Freese, Michael; Honegger, Ursina; Wild, Damian; Rentsch, Katharina; Osswald, Stefan; Zellweger, Michael J; Mueller, Christian.
in: AM J MED, Jahrgang 127, Nr. 5, 05.2014, S. 427-35.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - B-type natriuretic peptide and clinical judgment in the detection of exercise-induced myocardial ischemia
AU - Lee, Gino
AU - Sou, Seoung Mann
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Oshima, Shino
AU - Hochgruber, Thomas
AU - Zürcher, Stephan
AU - Matter, Deborah
AU - Tanglay, Yunus
AU - Freese, Michael
AU - Honegger, Ursina
AU - Wild, Damian
AU - Rentsch, Katharina
AU - Osswald, Stefan
AU - Zellweger, Michael J
AU - Mueller, Christian
N1 - Copyright © 2014 Elsevier Inc. All rights reserved.
PY - 2014/5
Y1 - 2014/5
N2 - BACKGROUND: Myocardial ischemia has been shown to be associated with increased levels of B-type natriuretic peptide (BNP). However, it remains unclear whether and how BNP levels could be used clinically in patients with suspected exercise-induced myocardial ischemia.METHODS: We enrolled 274 consecutive patients with suspected exercise-induced myocardial ischemia referred for evaluation by rest/bicycle myocardial perfusion single-photon emission computed tomography (SPECT). All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of myocardial ischemia using a visual analogue scale twice: once before and once after bicycle exercise stress testing. BNP measurements were obtained before, immediately after, and 2 hours after stress testing in a blinded manner. The presence of myocardial ischemia was adjudicated on the basis of perfusion SPECT combined with coronary angiography findings.RESULTS: Exercise-induced myocardial ischemia was adjudicated to be present in 103 patients (38%). BNP levels were significantly higher at all time points in patients with myocardial ischemia compared with those without (P < .01 for all). The accuracy of BNP levels as quantified by the area under the receiver operating characteristic curve (AUC) was similar among the time points evaluated (AUC, 0.677-0.697). Combining clinical judgment before exercise testing with BNP levels at rest increased diagnostic accuracy from AUC 0.708 to 0.754 (P = .018). When combining clinical judgment after exercise testing with BNP levels, AUC increased from 0.741 to 0.771 (P = .055).CONCLUSIONS: Combining clinical judgment with BNP levels increased the diagnostic accuracy regarding the presence of myocardial ischemia.
AB - BACKGROUND: Myocardial ischemia has been shown to be associated with increased levels of B-type natriuretic peptide (BNP). However, it remains unclear whether and how BNP levels could be used clinically in patients with suspected exercise-induced myocardial ischemia.METHODS: We enrolled 274 consecutive patients with suspected exercise-induced myocardial ischemia referred for evaluation by rest/bicycle myocardial perfusion single-photon emission computed tomography (SPECT). All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of myocardial ischemia using a visual analogue scale twice: once before and once after bicycle exercise stress testing. BNP measurements were obtained before, immediately after, and 2 hours after stress testing in a blinded manner. The presence of myocardial ischemia was adjudicated on the basis of perfusion SPECT combined with coronary angiography findings.RESULTS: Exercise-induced myocardial ischemia was adjudicated to be present in 103 patients (38%). BNP levels were significantly higher at all time points in patients with myocardial ischemia compared with those without (P < .01 for all). The accuracy of BNP levels as quantified by the area under the receiver operating characteristic curve (AUC) was similar among the time points evaluated (AUC, 0.677-0.697). Combining clinical judgment before exercise testing with BNP levels at rest increased diagnostic accuracy from AUC 0.708 to 0.754 (P = .018). When combining clinical judgment after exercise testing with BNP levels, AUC increased from 0.741 to 0.771 (P = .055).CONCLUSIONS: Combining clinical judgment with BNP levels increased the diagnostic accuracy regarding the presence of myocardial ischemia.
KW - Aged
KW - Area Under Curve
KW - Biomarkers/blood
KW - Coronary Artery Disease/blood
KW - Exercise
KW - Exercise Test
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Ischemia/blood
KW - Natriuretic Peptide, Brain/blood
KW - Predictive Value of Tests
KW - ROC Curve
KW - Sensitivity and Specificity
KW - Sex Distribution
KW - Tomography, Emission-Computed, Single-Photon
U2 - 10.1016/j.amjmed.2014.01.009
DO - 10.1016/j.amjmed.2014.01.009
M3 - SCORING: Journal article
C2 - 24486287
VL - 127
SP - 427
EP - 435
JO - AM J MED
JF - AM J MED
SN - 0002-9343
IS - 5
ER -
