Key result
Plasma BNP levels show no association with ischemia or ventricular arrhythmias during exercise SPECT.
Why the study?
Are plasma BNP levels associated with the occurrence of ischemia or ventricular arrhythmias during symptom-limited exercise in low-risk patients?
Cross-Sectional (n=63)
No
Are plasma BNP levels associated with the occurrence of ischemia or ventricular arrhythmias during symptom-limited exercise in low-risk patients?
Absolute Event Rate: 17.5% vs 45.6%
p-value: p=0.137
Plasma BNP values at baseline or after exercise are not associated with myocardial ischemia or ventricular arrhythmias during exercise SPECT, limiting its usefulness as a marker for acute ischemia.
BNP should not guide ischemia or arrhythmia risk assessment during exercise SPECT in low-risk patients; leaves open its role in higher-risk groups or alternative settings.
INTRODUCTION: The usefulness of B-type natriuretic peptide (BNP) as a marker of ischemia is controversial. BNP levels have predicted arrhythmias in various settings, but it is unknown whether they are related to exercise-induced ischemic ventricular arrhythmias. MATERIAL AND METHODS: We analyzed in 63 patients (64 ±14 years, 65% male, 62% with known coronary disease) undergoing exercise stress single-photon emission computed tomography (SPECT) the association between plasma BNP values (before and 15 min after exercise) and the occurrence of ischemia or ventricular arrhythmias during the test. RESULTS: Exercise test (8.1 ±2.7 min, 7.4 ±8.1 metabolic equivalents, 82 ±12% of maximal predicted heart rate) induced reversible perfusion defects in 23 (36%) patients. Eight (13%) patients presented significant arrhythmias (≥ 7 ventricular premature complexes/min, couplets, or non-sustained ventricular tachycardia during exercise or in the first minute of recovery). Median baseline BNP levels were 17.5 (12.4-66.4) pg/ml in patients developing scintigraphic ischemia and 45.6 (13.2-107.4) pg/ml in those without ischemia (p = 0.137). The BNP levels increased after exercise (34.4 (15.3-65.4)% increment over baseline, p < 0.001), but the magnitude of this increase was not related to SPECT positivity (35.7 (18.8-65.4)% vs. 27.9 (5.6-64.0)% in patients with and without ischemia, respectively, p = 0.304). No significant association was found between BNP values (at baseline or their change during the test) and ventricular arrhythmias. CONCLUSIONS: Plasma BNP values - at baseline or after exercise - were not associated with myocardial ischemia or with ventricular arrhythmia during exercise SPECT. These results highlight the limited usefulness of this biomarker to assess acute ischemia.
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Porta‐Sánchez et al. (2016) conducted a cross-sectional in Suspected or known coronary artery disease (n=63). Plasma B-type natriuretic peptide (BNP) levels vs. Patients without ischemia or ventricular arrhythmias was evaluated on Baseline plasma BNP levels in relation to exercise-induced scintigraphic ischemia (p=0.137). Plasma BNP values, either at baseline or their increment after exercise, were not significantly associated with the occurrence of myocardial ischemia or ventricular arrhythmias during exercise SPECT.
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