Use of changes in B-type natriuretic peptides to detect ischemia in selected patients

Int J Cardiol. 2009 Jul 24;136(1):40-6. doi: 10.1016/j.ijcard.2008.04.024. Epub 2008 Jul 15.


Background: There is accumulating evidence that transient exercise-induced ischemia triggers the release of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The aim of this study was to either confirm or refute a previous investigation suggesting that myocardial ischemia can reliably be detected by exercise-induced changes in BNP or NT-proBNP levels in selected patients.

Methods: A total of 139 consecutive patients with normal left ventricular function and normal resting BNP and NT-proBNP levels referred for rest/stress myocardial perfusion single-photon emission computed tomography (SPECT) were analyzed. Levels of BNP and NT-proBNP were determined before and immediately after symptom-limited bicycle ergometry.

Results: Inducible myocardial ischemia on perfusion images was detected in 46 patients (33%). Median exercise-induced increases in BNP (DeltaBNP) and NT-proBNP (DeltaNT-proBNP) were similar in patients with and without inducible ischemia (DeltaBNP 12.7 pg/ml vs. 9.4 pg/ml, p=0.109; DeltaNT-proBNP 7 pg/ml vs. 6 pg/ml, p=0.309). The area under the receiver operating characteristic curve for the ability to detect myocardial ischemia was 0.583 (95% CI, 0.479-0.688) for DeltaBNP, and 0.553 (95% CI, 0.450-0.656) for DeltaNT-proBNP.

Conclusions: Exercise-induced changes in BNP and NT-proBNP do not reliably detect myocardial ischemia in selected patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / blood*
  • Myocardial Ischemia / diagnosis*
  • Myocardial Ischemia / diagnostic imaging
  • Natriuretic Peptide, Brain / biosynthesis
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / biosynthesis
  • Peptide Fragments / blood
  • Protein Precursors / biosynthesis
  • Protein Precursors / blood
  • Tomography, Emission-Computed, Single-Photon / methods


  • Biomarkers
  • Peptide Fragments
  • Protein Precursors
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain