The predictive value of proBNP levels to determine the presence and severity of coronary artery disease in patients with a positive or inconclusive exercise stress test
Adam, Jamila Khatoon
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Background Several clinical studies have shown increased levels of N Terminal-Pronatriuretic Peptide (NT-proBNP) during epi- sodes of coronory ischaemia. Consistent with this observation, both Brain Natriuretic Peptide (BNP) and NT-proBNP correlated to severity, location, and extent of angiographic coronary artery disease (CAD). The main objective of this study was to identify the possible value of NT-proBNP level which indicates CAD. Methods Sixty patients with signs and symptoms of CAD were recruited for this study. They were divided into two groups; Group A, consisted of thirty patients with a positive Exercise Stress Test (EST) and Group B, consisted of thirty patients with an inconclusive EST. After the EST, all patients from both groups were required to have a NT-proBNP blood test, a left and right coronary angiogram and a left ventriculogram. Results Post EST NT-proBNP levels, in both groups, increased in the presence of CAD (p<0.001). For the positive EST group, the area under the ROC curve was 0.975 (p<0.001). A cut- off value of 120 pg/ml was identified with the highest sensitivity (95.7%) and specificity (100%). For patients in the inconclusive EST group, the area under the ROC curve was 0.912 (p<0.001). A cut-off value of 85 pg/ml was identified with the highest sensitivity (87.5%) and specificity (86.4%). Conclusion EST is relatively inaccurate at predicting CAD in patients with inconclusive ESTs. The need for an additional tool, such as NT-proBNP measurements post inconclusive EST is warranted in the determination of the presence of CAD.
Adam, J.K., Pearce, A., Naidoo, N., and Rmaih, W.N.S. 2012. The predictive value of proBNP levels to determine the presence and severity of coronary artery disease in patients with a positive or inconclusive exercise stress test. Medical Technology SA, 26(1): 13-17.