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    Provocative biomarker stress test: Stress-delta N-terminal pro-B type natriuretic peptide

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    Author
    Limkakeng, Jr., A.T.
    Leahy, J.C.
    Griffin, S.M.
    Date
    2018
    Journal
    Open Heart
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
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    See at
    https://dx.doi.org/10.1136/openhrt-2018-000847
    Abstract
    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 4hours 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 2hours were 10.4 (IQR 6.0-51.7) ng/L vs 1.7 (IQR -0.4 to 8.7) ng/L, and at 4hours 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. Copyright Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
    Sponsors
    The Duke Office of Clinical Research's support of this project was made possible by Grant Number 1 UL1 RR024128-01 from the National Center for Research Resources (NCRR).
    Keyword
    acute coronary syndrome
    biomarkers
    coronary artery disease
    echocardiography
    emergency medicine
    myocardial ischaemia and infarction (IHD)
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054758920&doi=10.1136%2fopenhrt-2018-000847&partnerID=40&md5=ae5bbfcb2da955137ac68de0a79bb117; http://hdl.handle.net/10713/9289
    ae974a485f413a2113503eed53cd6c53
    10.1136/openhrt-2018-000847
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