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【medical-news】BNP和其他新兴的损伤标记物与传统
Objective: To investigate the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a predictive marker for angiographically significant coronary artery disease (CAD) and CAD severity compared with other newer biochemical risk markers and classic risk factors in patients with clinically suspected CAD.
Design: Cross-sectional evaluation of NT-proBNP in a large consecutive series of patients without a history of myocardial infarction referred for elective coronary angiography (CAG) between March 2004 and January 2005. The value of NT-proBNP for predicting CAD was assessed and compared with high sensitivity C-reactive protein (hs-CRP), -glutamyltransferase (GGT) and traditional risk factors.
Setting: Tertiary care centre, Department of Cardiology, Innsbruck Medical University, Austria.
Patients: 561 men and 287 women aged between 20–86 years (median 65 years).
Interventions: None.
Main outcome measures: Association of NT-proBNP with the severity of CAD, left ventricular dysfunction and comparison of predictive values of NT-proBNP, hs-CRP, GGT and traditional CAD risk factors.
Results: Of all tested newer biochemical risk markers NT-proBNP performed best. In a multinomial logistic regression model NT-proBNP but not hs-CRP or GGT was significantly associated with three-vessel CAD adjusted for age, sex, ventricular, renal function and classic risk factors (odds ratio = 1.667; 95% CI 1.003 to 2.772; p = 0.049). However, NT-proBNP had no additive predictive value to traditional cardiovascular risk factors for the prediction of angiographically significant CAD in a binary logistic regression model.
Conclusions: The predictive value of NT-proBNP for CAD severity is better than that of hs-CRP or GGT. However, NT-proBNP is also of limited value compared with traditional risk factors for predicting significant CAD.
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There is growing clinical interest in the use of newer biomarkers to identify individuals who are at risk for the development of myocardial infarction and who could benefit from preventive measures. B-type natriuretic peptide (BNP) and the N-terminal fragment (NT-proBNP) of its pro-hormone are already well established as diagnostic markers of heart failure and as risk markers in heart failure and acute coronary syndromes.1 2 The predominant stimulus for the synthesis of BNP is an increase in ventricular wall stretch.3 4 However, recent evidence suggests that ischaemia may be an additional stimulus for synthesis and BNP release.5–7 Myocardial ischaemia can induce a reversible increase in regional wall stress that may lead to augmented natriuretic peptide release. The observations that natriuretic peptide levels are increased in patients with stable coronary artery disease (CAD) after episodes of ischaemia and the association between BNP and inducible myocardial ischaemia 8–11 are in agreement with these experimental and previous clinical findings.5–7
In addition, several clinical studies have investigated the relation between vascular inflammation and atherosclerosis.12 High sensitivity C-reactive protein (hs-CRP) emerged as the most predictive inflammatory marker for CAD, which is suitable for routine measurement.13 CRP is an acute phase reactant that is synthesised in the liver. It is a sensitive marker for inflammatory response and already clinically used for cardiovascular risk stratification.13 Further, -glutamyltransferase (GGT), a commonly used diagnostic marker for liver function,13 has recently gained interest as a marker for cardiovascular risk stratification as well.14 Several recent studies showed that it is also associated with morbidity and mortality from causes other than liver disease, including cardiovascular disease.14 15
The available data on the comparative values of NT-proBNP, hs-CRP, GGT and traditional risk factors as a screening tool for the prediction of angiographically significant stenoses in patients without a history of previous myocardial infarction and with suspected CAD is limited. Therefore we conducted the present study with the aim of investigating the association of NT-proBNP concentrations with the severity of CAD in patients without previous myocardial infarction, and to test its usefulness as a predictor of significant CAD and the severity of CAD at coronary angiography (CAG) compared with the above mentioned other newer biochemical risk markers (hs-CRP, GGT) and with the traditional clinical risk factors for the presence of CAD.
Heart 2009;95:297-303 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-02-20 17:11
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