期刊
AMERICAN HEART JOURNAL
卷 151, 期 6, 页码 1223-1230出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2005.06.045
关键词
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Background Exercise electrocardiography (ECG) has high specificity but limited sensitivity for the detection of myocardial ischemia. The aim of this study was to determine whether measurement of B-type natriuretic peptide (BNP) can improve the diagnostic accuracy of exercise ECG. Methods A total of 256 consecutive patients with suspected myocardial ischemia referred for rest/ergometry myocardial perfusion single-photon emission computed tomography were enrolled. Levels of BNP were determined before and I minute after maximal exercise. Result Inducible myocardial ischemia on perfusion images was detected in 127 patients (49.6%). Median BNP levels at rest and after peak exercise were higher in patients with than without inducible ischemia (71 pg/mL vs 38 pg/mL, P <.001; and 88 vs 52 pg/mL, P <.001, respectively). Compared with patients in the lowest peak exercise BNP quartile, those in the highest quartile of peak exercise BNP had more than 3 times the risk of inducible ischemia (adjusted relative risk 3.3, 95% Cl 1.3-8.6, P =.0 15). Using 110 pg/mL as a cutoff, the combination of exercise ECG and peak exercise BNP level distinguished between ischemic and nonischemic patients more accurately than the exercise ECG alone (67% vs 60%, P =.024). Although the increase in accuracy was similar for the combination of exercise ECG with baseline BNP or ABNP, overall, peak exercise BNP seemed to be the preferred measurement. Conclusions B-type natriuretic peptide levels are associated with inducible myocardial ischemia. The use of BNP levels improves the diagnostic accuracy of exercise ECG.
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