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Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia

Marc S. Sabatine, MD, MPH^*,*, David A. Morrow, MD, MPH, FACC^*, James A. de Lemos, MD, FACC, Torbjorn Omland, MD, Milind Y. Desai, MD, Milenko Tanasijevic, MD, MBA^||, Christian Hall, MD, PhD, FACC^¶, Carolyn H. McCabe, BS^* and Eugene Braunwald, MD, FACC^*

^* TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
University of Texas Southwestern Medical Center, Dallas, Texas
Department of Medicine, Akershus Hospital, Oslo, Norway
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
^|| Clinical Laboratories Division, Pathology Department, Brigham and Women's Hospital, Boston, Massachusetts
^¶ Institute of Clinical Biochemistry, Rikshospitalet, University of Oslo, Oslo, Norway

View larger version (25K): [in a new window]   Figure 1 Median B-type natriuretic peptide (BNP) levels in patients with no (open circles), mild-to-moderate (black triangles), and severe (black squares) ischemia, in whom samples were available at all three time points (baseline, immediately [Immed] after stress testing, and 4 h after stress testing). The p values are for trend across ischemic categories at each time point. IQR = interquartile range; Mod = moderate.

View larger version (28K): [in a new window]   Figure 2 Median N-terminal fragment of BNP pro-hormone (NT-pro-BNP) levels in patients with no (open circles), mild-to-moderate (black triangles), and severe (black squares) ischemia, in whom samples were available at all three time points (baseline, immediately [Immed] after stress testing, and 4 h after stress testing). The p values are for trend across ischemic categories at each time point. IQR = interquartile range; Mod = moderate.

View larger version (29K): [in a new window]   Figure 3 Median N-terminal fragment of ANP pro-hormone (NT-pro-ANP) levels in patients with no (open circles), mild-to-moderate (black triangles), and severe (black squares) ischemia, in whom samples were available at all three time points (baseline, immediately [Immed] after stress testing, and 4 h after stress testing). The p values are for trend across ischemic categories at each time point. IQR = interquartile range; Mod = moderate.

View larger version (19K): [in a new window]   Figure 4 Median post-stress test B-type natriuretic peptide (BNP) levels with interquartile ranges in patients with none, mild-to-moderate, and severe ischemia, stratified into those with ejection fractions 50% (black bars) and <50% (white bars). Numbers within each bar represent the number of patients in that group. The p values are for trend across ischemic categories (p = 0.14 for patients with ejection fraction <0.5; p = 0.012 for patients with ejection fraction 0.5.). ETT = exercise tolerance test; Mod = moderate.

View larger version (17K): [in a new window]   Figure 5 Median changes in B-type natriuretic peptide (BNP) levels in response to exercise stress testing in patients with no ischemia (white bar), with no ischemia on scintigraphy but subsequently shown to have critical coronary disease (light gray bar), with mild-to-moderate ischemia (dark gray bar), and with severe ischemia (black bar). Numbers within each bar represent the number of patients in that group. The p values by each bar are for the median change. The p value at the far right is for the trend across ischemic categories. cath = cardiac catheterization; ECG = electrocardiographic; Immed = immediately; IQR = interquartile range; sx = symptoms.

View larger version (18K): [in a new window]   Figure 6 Point estimates and 95% confidence intervals (CI) for the odds ratio (OR) for the components of the Duke Treadmill Score and a post-stress test B-type natriuretic peptide (BNP) 80 pg/ml. Adj = adjusted; ETT = exercise tolerance test.

View larger version (14K): [in a new window]   Figure 7 Proportion with inducible ischemia among patients categorized by the number of risk factors (male gender, limiting angina, ST-segment depression, post-stress test B-type natriuretic peptide level 80 pg/ml). Numbers within each bar represent the number of patients in that group. The p value is for trend across categories.