Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK.
Eur J Heart Fail. 2014 Jan;16(1):56-67. doi: 10.1093/eurjhf/hft130. Epub 2013 Dec 3.
Plasma BNP and high-sensitivity cardiac troponin-T (hs-TnT) are elevated by both ischaemia and LV systolic dysfunction (LVSD). As a result, it is unknown whether BNP and/or hs-TnT could be useful biomarkers to identify ischaemia in the presence of LVSD.
Three separate patient populations were studied. Study A (n = 500) involved consecutive patients undergoing clinically indicated myocardial perfusion scintigraphy, study B (n = 100) included patients with vascular disease but no known cardiac disease, and study C (n = 300) recruited primary prevention patients with controlled risk factors. Levels of BNP and hs-TnT were measured prior to the stress testing to detect myocardial ischaemia. The prevalence of myocardial ischaemia was 28.2, 28, and 6.3% in study A, B, and C, respectively. For BNP, area under curve (AUC) values to identify ischaemia in the presence and absence of coincidental LVSD were: 0.73 vs. 0.63 (study A), 0.90 vs. 0.81 (study B), and 0.83 vs. 0.80 (study C). Equivalent figures for hs-TnT were: 0.64 vs. 0.60 (study A), 0.75 vs. 0.68 (study B), and 0.53 vs. 0.68 (study C). BNP and hs-cTnT, when combined together, performed better with an AUC of 0.75 vs. 0.65 (study A), 0.91 vs. 0.92 (study B), and 0.84 vs. 0.83 (study C).
In three separate populations a consistent finding is that BNP is increased further by myocardial ischaemia even in the presence of LVSD. A disproportionately high BNP for the degree of LVSD might be due to (unsuspected) ischaemia, and a disproportionately low BNP could be useful as a 'rule out' test for ischaemia even in the presence of LVSD.
BNP 和高敏心肌肌钙蛋白 T（hs-TnT）可因缺血和左心室收缩功能障碍（LVSD）而升高。因此，尚不清楚 BNP 和/或 hs-TnT 是否可作为有用的生物标志物，用于在存在 LVSD 的情况下识别缺血。
研究了三个独立的患者群体。研究 A（n=500）纳入了连续进行临床指征明确的心肌灌注闪烁显像的患者，研究 B（n=100）纳入了有血管疾病但无已知心脏疾病的患者，研究 C（n=300）招募了有控制危险因素的一级预防患者。在进行应激试验以检测心肌缺血之前，测量了 BNP 和 hs-TnT 的水平。研究 A、B 和 C 中，心肌缺血的患病率分别为 28.2%、28%和 6.3%。对于 BNP，在存在和不存在巧合性 LVSD 的情况下，识别缺血的曲线下面积（AUC）值分别为：0.73 比 0.63（研究 A）、0.90 比 0.81（研究 B）和 0.83 比 0.80（研究 C）。hs-TnT 的相应数值为：0.64 比 0.60（研究 A）、0.75 比 0.68（研究 B）和 0.53 比 0.68（研究 C）。BNP 和 hs-cTnT 联合使用时，AUC 值分别为 0.75 比 0.65（研究 A）、0.91 比 0.92（研究 B）和 0.84 比 0.83（研究 C），表现更好。
在三个独立的人群中，一致的发现是，即使存在 LVSD，BNP 也会因心肌缺血而进一步升高。LVSD 程度不成比例地升高的 BNP 可能是由于（未被怀疑的）缺血所致，而不成比例地降低的 BNP 可能有助于作为即使存在 LVSD 情况下的缺血“排除”试验。
