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

Abstract

ObjectiveStress 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.MethodsWe 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.ResultsAmong 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).ConclusionAmong 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.

A Precision Medicine Approach to Stress Testing Using Metabolomics and Microribonucleic Acids

“…We have previously examined the utility of blood-based biomarkers to enhance cardiac stress testing (19,21,22). In this pilot study, we outline the methodology to further develop a biomarker-augmented stress test using a precision medicine approach.…”

“…We used peripheral blood samples in EDTA collection tubes from a biorepository created to study changes in high-sensitivity troponin and B-type natriuretic peptide during stress testing. This biorepository has been previously described (21,22). Briefly, samples were collected from adult emergency department (ED) patients who had symptoms of ACS and who underwent stress testing in our observation unit.…”

Cardiologia Esportiva: Desafios E Avanços Na Avaliação Cardíaca De Atletas De Alto Rendimento

“…Por isso, é mais utilizado em pacientes idosos com disfunção cardíaca conhecida 71 . Seus níveis podem aumentar em pessoas não treinadas que praticam atividades físicas extenuantes, mas não são significativos para uma doença cardíaca isquêmica, a menos que estejam correlacionados com alterações no ECG ou com um aumento nos níveis de cTn 72 .…”

Cardiac Biomarkers in Sports Cardiology

“…Therefore, it has more use in elderly patients with known cardiac dysfunction [77][78][79]. Their levels may increase in non-trained people who engage in strenuous physical activities, but they are not significant for an ischemic cardiac disease, unless correlated with ECG changes or with a rise in cTn levels [45,[80][81][82].…”