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CLINICAL RESEARCH: BIOMARKER

Short-Term Serial Sampling of Natriuretic Peptides in Patients Presenting With Chest Pain

Gene Kwan, MD^_*, Susan R. Isakson, BS^_*, Jennifer Beede, MS^_*, Paul Clopton, MS^_*, Alan S. Maisel, MD, FACC^_* and Robert L. Fitzgerald, PhD^,_*

^_* Division of Cardiology, Department of Medicine, Veterans Affairs Healthcare System San Diego and University of California, San Diego, California
Department of Pathology, Veterans Affairs Healthcare System San Diego, and Department of Pathology, University of California, San Diego, California.

Manuscript received May 18, 2006; revised manuscript received October 31, 2006, accepted November 7, 2006.

^_* Reprint requests and correspondence: Dr. Robert L. Fitzgerald, VAMC-113, 3350 La Jolla Village Drive, San Diego, California 92161. (Email: rlfitzgerald{at}vapop.ucsd.edu).

Objectives: The purpose of this study was to characterize the diagnostic and prognostic utility of short-term dynamic changes in natriuretic peptides in patients presenting with chest pain.

Background: Although single levels of natriuretic peptides in patients admitted for acute coronary syndromes (ACS) have important prognostic value, it is unclear whether serial sampling of natriuretic peptides might have both diagnostic and prognostic value in the setting of chest pain.

Methods: We followed 276 patients for 90 days who presented to the emergency department with chest pain. We sampled brain natriuretic peptide (BNP) and amino-terminal (NT)-proBNP up to 5 times within 24 h of presentation and again at discharge. Follow-up data was collected at 30 and 90 days after admission. Adverse events included emergency department visits for chest pain, cardiac readmission, and death. We assessed the prognostic and diagnostic value of baseline natriuretic peptide measurements with receiver-operating characteristic analyses.

Results: Natriuretic peptides were diagnostic for congestive heart failure (CHF) and new-onset CHF but less so for ACS. The prognostic utility of serial sampling was evaluated through testing the statistical contribution of each future time point (as well as variability over time) over and above the baseline values in logistic regression models.

Conclusions: Baseline elevated BNP and NT-proBNP concentrations were predictive of adverse events at 30 and 90 days. Serial sampling did not improve the prognostic value of BNP or NT-proBNP.

Abbreviations and Acronyms   ACS = acute coronary syndromes   BNP = brain natriuretic peptide   CI = confidence interval   MI = myocardial infarction   NT-proBNP = amino-terminal pro-brain natriuretic peptide   ROC = receiver-operating characteristic

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