TY - JOUR
T1 - Stress-Delta B-Type Natriuretic Peptide Does Not Exclude ACS in the ED
AU - Susman, Stephen J.
AU - Bouffler, Andrew
AU - Gordee, Alexander
AU - Kuchibhatla, Maragatha
AU - Leahy, J. Clancy
AU - Griffin, S. Michelle
AU - Christenson, Robert H.
AU - Newby, L. Kristin
AU - Limkakeng, Alexander T.
N1 - Funding Information:
Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest: Employment or Leadership: R.H. Christenson, The Journal of Applied Laboratory Medicine, AACC; L.K. Newby, David H Murdock Research Institute, AstraZeneca Healthcare Foundation, AHA. Consultant or Advisory Role: L.K. Newby, MESA OSMB (unremunerated), consulting fees from Roche Diagnostics, Beckman Coulter, Medtronic, NHLBI. Stock Ownership: J.C. Leahy, stock and stock options from the Duke employee retirement fund. Honoraria: None declared. Research Funding: The Duke Biostatistics, Epidemiology, and Research Design Core was supported by CTSA Grant (UL1TR002553) from the National Center for Advancing Translational Sciences (NCATS) of the NIH. Abbott Laboratories provided financial support for this project via an investigator-initiated grant. Financial support was not dependent on the results of the study. Abbott Laboratories provided salary support for investigators to our institution and tested all samples. The investigators retained control of the data throughout the entire study and the decision of whether and how to publish the results. A. Limkakeng, Department of Defense/Henry Jackson Foundation, Ischemia Care Ltd., GE, Astrazeneca, Forest Devices, Inc, Regeneron, Becton Dickinson, SENSE Neuro Diagnostics, Ophirex, Inc., and research grants to Duke University by Roche Diagnostics, Bristol Meyers Squibb, Ischemia Care Ltd, GE, Astrazeneca, Siemens Healthcare, NIH; J.C. Leahy, funding from the Duke University Emergency Medicine; L.K. Newby, research grants to Duke University from BioKier, NC DHHS, NIH, Roche Diagnostics. Expert Testimony: None declared. Patents: None declared.
Publisher Copyright:
© 2022 American Association for Clinical Chemistry.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Background: There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, which can be used for emergency department (ED) acute coronary syndrome (ACS) risk stratification. Methods: In a prospective study, we enrolled 340 patients over the age of 30 receiving an exercise echocardiography stress test in an ED observational unit for suspected ACS. We collected blood samples at baseline and at 2 and 4h post-stress test, measuring the relative and absolute changes (stress-delta) in plasma BNP concentrations. In addition, patients were contacted at 90 days and at 1 year posttest for a follow-up. We calculated the diagnostic test characteristics of stress-delta BNP for a composite outcome of ischemic imaging on stress echocardiogram, nonelective percutaneous coronary intervention, coronary artery bypass graft surgery, subsequent acute myocardial infarction, or cardiac death at 1 year via a logistic regression. We analyzed the 2-h BNP concentrations using an ANOVA model to adjust for the baseline BNP level. Results: Baseline and 2-h post-stress BNP were both higher in the positive outcome group, but the stress-delta BNP was not. Stress-delta BNP had a sensitivity and specificity, respectively, of 53% and 76% at 2h and 67% and 68% at 4h. It was noted that patients with the composite outcome had a higher baseline BNP level. Conclusions: BNP stress-deltas are poor diagnostic means for ACS risk stratification, but resting BNP remains a promising prognostic tool for ED patients with suspected ACS.
AB - Background: There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, which can be used for emergency department (ED) acute coronary syndrome (ACS) risk stratification. Methods: In a prospective study, we enrolled 340 patients over the age of 30 receiving an exercise echocardiography stress test in an ED observational unit for suspected ACS. We collected blood samples at baseline and at 2 and 4h post-stress test, measuring the relative and absolute changes (stress-delta) in plasma BNP concentrations. In addition, patients were contacted at 90 days and at 1 year posttest for a follow-up. We calculated the diagnostic test characteristics of stress-delta BNP for a composite outcome of ischemic imaging on stress echocardiogram, nonelective percutaneous coronary intervention, coronary artery bypass graft surgery, subsequent acute myocardial infarction, or cardiac death at 1 year via a logistic regression. We analyzed the 2-h BNP concentrations using an ANOVA model to adjust for the baseline BNP level. Results: Baseline and 2-h post-stress BNP were both higher in the positive outcome group, but the stress-delta BNP was not. Stress-delta BNP had a sensitivity and specificity, respectively, of 53% and 76% at 2h and 67% and 68% at 4h. It was noted that patients with the composite outcome had a higher baseline BNP level. Conclusions: BNP stress-deltas are poor diagnostic means for ACS risk stratification, but resting BNP remains a promising prognostic tool for ED patients with suspected ACS.
KW - ACS risk stratification
KW - BNP
KW - biomarkers
KW - myocardial ischemia
KW - stress test
UR - http://www.scopus.com/inward/record.url?scp=85137137110&partnerID=8YFLogxK
U2 - 10.1093/jalm/jfac027
DO - 10.1093/jalm/jfac027
M3 - Article
C2 - 35587711
AN - SCOPUS:85137137110
SN - 2576-9456
VL - 7
SP - 1098
EP - 1107
JO - The journal of applied laboratory medicine
JF - The journal of applied laboratory medicine
IS - 5
ER -