Singh Harsimran S, Bibbins-Domingo Kirsten, Ali Sadia, Wu Alan H B, Schiller Nelson B, Whooley Mary A
Division of Cardiology, Columbia University, New York Presbyterian Hospital, New York, New York, USA.
Clin Cardiol. 2009 Aug;32(8):447-53. doi: 10.1002/clc.20569.
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.
Resting NT-proBNP levels are associated with inducible ischemia in patients with stable CHD.
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.
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).
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.
B型利钠肽（BNP）可预测冠心病（CHD）患者的诱发型缺血。N末端B型利钠肽原（NT-proBNP）与缺血的关联强度是否相当尚不确定。
静息NT-proBNP水平与稳定型CHD患者的诱发型缺血相关。
我们对901例稳定型CHD门诊患者进行了一项横断面研究。在所有患者进行运动平板试验和负荷超声心动图检查之前测量NT-proBNP。此外，对355名参与者的一个子集测量了血浆BNP。采用逻辑回归分析NT-proBNP和BNP四分位数与诱发型缺血的关联。
216例（24%）患者发现有诱发型缺血。NT-proBNP水平最高四分位数组（>410 pg/ml）中诱发型缺血的比例为42%（95/225），最低四分位数组（0 - 72 pg/ml）中为9%（21/226）。最高四分位数组诱发型缺血的几率比最低四分位数组高7倍（比值比[OR]：7.1，95%置信区间[CI]：4.2 - 12；P < 0.0001）。在对传统心血管危险因素、左心室射血分数和舒张功能障碍进行校正后，这种关联仍然显著（OR：3.6，95% CI：1.4 - 9.1；P = 0.009）。在同时测量了NT-proBNP和BNP的亚组中，两种利钠肽均能预测缺血。对于诱发型缺血，NT-proBNP的多变量校正c统计量为0.71，BNP为0.62（作为连续变量输入）。
静息NT-proBNP水平与稳定型CHD门诊患者的诱发型缺血独立相关。利钠肽基线升高可能表明CHD高危患者存在亚临床诱发型缺血。
