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  • Title: B-type natriuretic peptide and clinical judgment in the detection of exercise-induced myocardial ischemia.
    Author: Lee G, Sou SM, Twerenbold R, Reichlin T, Oshima S, Hochgruber T, Zürcher S, Matter D, Tanglay Y, Freese M, Honegger U, Wild D, Rentsch K, Osswald S, Zellweger MJ, Mueller C.
    Journal: Am J Med; 2014 May; 127(5):427-35. PubMed ID: 24486287.
    Abstract:
    BACKGROUND: Myocardial ischemia has been shown to be associated with increased levels of B-type natriuretic peptide (BNP). However, it remains unclear whether and how BNP levels could be used clinically in patients with suspected exercise-induced myocardial ischemia. METHODS: We enrolled 274 consecutive patients with suspected exercise-induced myocardial ischemia referred for evaluation by rest/bicycle myocardial perfusion single-photon emission computed tomography (SPECT). All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of myocardial ischemia using a visual analogue scale twice: once before and once after bicycle exercise stress testing. BNP measurements were obtained before, immediately after, and 2 hours after stress testing in a blinded manner. The presence of myocardial ischemia was adjudicated on the basis of perfusion SPECT combined with coronary angiography findings. RESULTS: Exercise-induced myocardial ischemia was adjudicated to be present in 103 patients (38%). BNP levels were significantly higher at all time points in patients with myocardial ischemia compared with those without (P < .01 for all). The accuracy of BNP levels as quantified by the area under the receiver operating characteristic curve (AUC) was similar among the time points evaluated (AUC, 0.677-0.697). Combining clinical judgment before exercise testing with BNP levels at rest increased diagnostic accuracy from AUC 0.708 to 0.754 (P = .018). When combining clinical judgment after exercise testing with BNP levels, AUC increased from 0.741 to 0.771 (P = .055). CONCLUSIONS: Combining clinical judgment with BNP levels increased the diagnostic accuracy regarding the presence of myocardial ischemia.
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