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. 2009 Aug 14;32(8):447–453. doi: 10.1002/clc.20569

N‐Terminal Pro‐B‐Type Natriuretic Peptide and Inducible Ischemia in the Heart and Soul Study

Harsimran S Singh 1, Kirsten Bibbins‐Domingo 2, Sadia Ali 3, Alan H B Wu 2, Nelson B Schiller 2,3, Mary A Whooley 2,3,4,✉
PMCID: PMC2790280  NIHMSID: NIHMS152898  PMID: 19685518

Abstract

Background

B‐type natriuretic peptide (BNP) is predictive of inducible ischemia in patients with coronary heart disease (CHD). Whether N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) has a comparable strength of association with ischemia is uncertain.

Hypothesis

Resting NT‐proBNP levels are associated with inducible ischemia in patients with stable CHD.

Methods

We performed a cross‐sectional study of 901 outpatients with stable CHD. NT‐proBNP was measured in all patients prior to exercise treadmill testing and stress echocardiography. In addition, plasma BNP was measured in a subset of 355 participants. Logistic regression was used to examine the association of NT‐proBNP and BNP quartiles with inducible ischemia.

Results

Inducible ischemia was found in 216 (24%) patients. The proportion with inducible ischemia ranged from 42% (95/225) in the highest quartile of NT‐proBNP levels (>410 pg/ml) to 9% (21/226) in the lowest quartile (0–72 pg/ml). The highest quartile had a 7‐fold greater odds of inducible ischemia than the lowest quartile (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 4.2–12; P < 0.0001). This association remained robust after adjustment for traditional cardiovascular risk factors, left ventricular ejection fraction, and diastolic dysfunction (OR: 3.6, 95% CI: 1.4–9.1; P = 0.009). In the subgroup with measurements of both NT‐proBNP and BNP, both natriuretic peptides were predictive of ischemia. The multivariable‐adjusted c‐statistics for inducible ischemia were 0.71 for NT‐proBNP and 0.62 for BNP (entered as continuous variables).

Conclusions

Resting NT‐proBNP levels are independently associated with inducible ischemia in outpatients with stable CHD. Baseline elevations of natriuretic peptide may indicate subclinical inducible ischemia in high risk patients with CHD. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

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