Provocative biomarker stress test: stress-delta N-terminal pro-B type natriuretic peptide.
| Autor: | Limkakeng AT Jr; Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Leahy JC; Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Griffin SM; Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Lokhnygina Y; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA., Jaffa E; Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Christenson RH; Department of Pathology, University of Maryland School of Medicine, Baltimore, USA., Newby LK; Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Open heart [Open Heart] 2018 Oct 08; Vol. 5 (2), pp. e000847. Date of Electronic Publication: 2018 Oct 08 (Print Publication: 2018). |
| DOI: | 10.1136/openhrt-2018-000847 |
| Abstrakt: | Objective: Stress testing is commonly performed in emergency department (ED) patients with suspected acute coronary syndrome (ACS). We hypothesised that changes in N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations from baseline to post-stress testing (stress-delta values) differentiate patients with ischaemic stress tests from controls. Methods: We prospectively enrolled 320 adult patients with suspected ACS in an ED-based observation unit who were undergoing exercise stress echocardiography. We measured plasma NT-proBNP concentrations at baseline and at 2 and 4 hours post-stress and compared stress-delta NT-proBNP between patients with abnormal stress tests versus controls using non-parametric statistics (Wilcoxon test) due to skew. We calculated the diagnostic test characteristics of stress-delta NT-proBNP for myocardial ischaemia on imaging. Results: Among 320 participants, the median age was 51 (IQR 44-59) years, 147 (45.9%) were men, and 122 (38.1%) were African-American. Twenty-six (8.1%) had myocardial ischaemia. Static and stress-deltas NT-proBNP differed at all time points between groups. The median stress-deltas at 2 hours were 10.4 (IQR 6.0-51.7) ng/L vs 1.7 (IQR -0.4 to 8.7) ng/L, and at 4 hours were 14.8 (IQR 5.0-22.3) ng/L vs 1.0 (-2.0 to 10.3) ng/L for patients with ischaemia versus those without. Areas under the receiver operating curves were 0.716 and 0.719 for 2-hour and 4-hour stress-deltas, respectively. After adjusting for baseline NT-proBNP levels, the 4-hour stress-delta NT-proBNP remained significantly different between the groups (p=0.009). Conclusion: Among patients with ischaemic stress tests, static and 4-hour stress-delta NT-proBNP values were significantly higher. Further study is needed to determine if stress-delta NT-proBNP is a useful adjunct to stress testing. Competing Interests: Competing interests: ATL would like to disclose that he has received research support from Roche Diagnostics, Siemens Healthcare Diagnostics and Abbott Laboratories, all of which are manufacturers of troponin and B-type natriuretic peptide assays. RHC has served as a consultant and member of scientific advisory groups for Roche Diagnostics, Quidel Diagnostics, Beckman Coulter Diagnostics, and Siemens Healthcare Diagnostics. LKN reports receiving consulting honoraria from Roche Diagnostics and Philips Healthcare, which produce products related to the current research, and from AstraZeneca HCF, Metanomics and Medscape. She has received research grants from Bristol-Myers Squibb, GlaxoSmithKline, Google Life Sciences (Verily), NHLBI and the MURDOCK Study. |
| Databáze: | MEDLINE |
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