Key result
BNP levels identified myocardial ischaemia even in the presence of left ventricular systolic dysfunction, yielding AUCs of 0.73, 0.90, and 0.83 across three distinct patient populations.
Why the study?
Can BNP and/or hs-TnT identify myocardial ischaemia in the presence of left ventricular systolic dysfunction?
Observational (n=900)
Can BNP and/or hs-TnT identify myocardial ischaemia in the presence of left ventricular systolic dysfunction?
Effect estimate: AUC for BNP 0.73 vs 0.63 (Study A), 0.90 vs 0.81 (Study B), 0.83 vs 0.80 (Study C)
BNP is increased further by myocardial ischaemia even in the presence of LVSD, suggesting its potential utility as a biomarker to rule out ischaemia in these patients.
May support BNP to exclude ischaemia in LVSD; hypothesis-generating pending prospective validation.
AIMS: Plasma BNP and high-sensitivity cardiac troponin-T (hs-TnT) are elevated by both ischaemia and LV systolic dysfunction (LVSD). As a result, it is unknown whether BNP and/or hs-TnT could be useful biomarkers to identify ischaemia in the presence of LVSD. METHODS AND RESULTS: Three separate patient populations were studied. Study A (n = 500) involved consecutive patients undergoing clinically indicated myocardial perfusion scintigraphy, study B (n = 100) included patients with vascular disease but no known cardiac disease, and study C (n = 300) recruited primary prevention patients with controlled risk factors. Levels of BNP and hs-TnT were measured prior to the stress testing to detect myocardial ischaemia. The prevalence of myocardial ischaemia was 28.2, 28, and 6.3% in study A, B, and C, respectively. For BNP, area under curve (AUC) values to identify ischaemia in the presence and absence of coincidental LVSD were: 0.73 vs. 0.63 (study A), 0.90 vs. 0.81 (study B), and 0.83 vs. 0.80 (study C). Equivalent figures for hs-TnT were: 0.64 vs. 0.60 (study A), 0.75 vs. 0.68 (study B), and 0.53 vs. 0.68 (study C). BNP and hs-cTnT, when combined together, performed better with an AUC of 0.75 vs. 0.65 (study A), 0.91 vs. 0.92 (study B), and 0.84 vs. 0.83 (study C). CONCLUSION: In three separate populations a consistent finding is that BNP is increased further by myocardial ischaemia even in the presence of LVSD. A disproportionately high BNP for the degree of LVSD might be due to (unsuspected) ischaemia, and a disproportionately low BNP could be useful as a 'rule out' test for ischaemia even in the presence of LVSD.
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Nadir et al. (2013) conducted an observational in Myocardial ischaemia and left ventricular systolic dysfunction (n=900). Brain Natriuretic Peptide (BNP) and high-sensitivity cardiac troponin-T (hs-TnT) was evaluated on Identification of myocardial ischaemia in the presence and absence of coincidental left ventricular systolic dysfunction (AUC for BNP 0.73 vs 0.63 (Study A), 0.90 vs 0.81 (Study B), 0.83 vs 0.80 (Study C)). BNP levels identified myocardial ischaemia even in the presence of left ventricular systolic dysfunction, yielding AUCs of 0.73, 0.90, and 0.83 across three distinct patient populations.
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