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Short-and long-term individual variation in NT-proBNP levels in patients with stable coronary artery disease
Orebro University Hospital. Department of Cardiology.
Uppsala University, Department of Radiology, Uppsala, Sweden.
Uppsala University, Department of Medical Sciences, Uppsala, Sweden.
Orebro University Hospital. Department of Cardiology.
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2013 (English)In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 422, no 25, 15-20 p.Article in journal (Refereed) Published
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Text
Abstract [en]

Background: In addition to diagnosis of heart failure (HF) natriuretic peptides (BNP and NT-proBNP) may be used for risk prediction in stable and acute coronary artery disease. The aim of the study was to evaluate the short- and long-term individual variation of NT-proBNP in patients with stable coronary artery disease.

Methods: Twenty-four patients with suspected stable coronary artery disease and scheduled for elective coronary angiography were included. Blood samples were drawn at enrolment and, on average 3 weeks later, serially the day prior to coronary angiography. NT-proBNP was determined using Elecsys proBNP sandwich immunoassay (Roche Diagnostics).

Results: The individual variation in NT-proBNP over 4 h was 11.8%, over 20 h 12.4% and over 3 weeks 20.4%. The corresponding positive and negative lognormal reference change values (RCV) were +41/-29%, +42/-30% and + 76/-43%, respectively. No significant circadian variation was found.

Conclusions: Our results suggest that an increase in NT-proBNP levels of >42% or a decrease of >30% is needed to indicate a reliable short-term change; and for a long-term change an increase of >76% or a decrease of >43% is required. This should be considered when interpreting changes in NT-proBNP levels.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 422, no 25, 15-20 p.
Keyword [en]
NT-proBNP, Cardiovascular diseases/diagnosis, Individual variation, Reference change values, Immunoassay
National Category
Family Medicine Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-49860DOI: 10.1016/j.cca.2013.03.025ISI: 000320894400004PubMedID: 23566928Scopus ID: 2-s2.0-84876716804OAI: oai:DiVA.org:oru-49860DiVA: diva2:920488
Available from: 2016-04-18 Created: 2016-04-18 Last updated: 2017-03-21Bibliographically approved
In thesis
1. Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
Open this publication in new window or tab >>Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overarching aim of the thesis was to explore the occurrence and clinical importance of two manifestations of myocardial injury; unrecognized myocardial injury (UMI) and altered levels of cardiac biochemical markers in patients with stable coronary artery disease (CAD).

Methods: A prospective multicenter cohort study investigated the prevalence, localization, size, and prognostic implication of UMI in 235 patients with stable CAD. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were used. The relationship between UMI and severe CAD and cardiac biochemical markers was explored. In a substudy the short- and longterm individual variation in cardiac troponins I and T (cTnI, cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were investigated.

Results: The prevalence of UMI was 25%. Subjects with severe CAD were significantly more likely to exhibit UMI than subjects without CAD. There was a strong association between stenosis ≥70% and presence of UMI in the myocardial segments downstream. The presence of UMI was associated with a significant threefold risk of adverse events during follow up. After adjustments UMI was associated with a nonsignificant numerically doubled risk. The levels of cTnI, NT-proBNP, and Galacin-3 were associated with the presence of UMI in univariate analyses. The association between levels of cTnI and presence of UMI remained significant after adjustment. The individual variation in cTnI, cTnT, and NT-proBNP in subjects with stable CAD appeared similar to the biological variation in healthy individuals.

Conclusions: UMI is common and is associated with significant CAD, levels of biochemical markers, and an increased risk for adverse events. A change of >50% is required for a reliable short-term change in cardiac troponins, and a rise of >76% or a fall of >43% is required to detect a long-term reliable change in NT-proBNP.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 125 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 142
Keyword
Unrecognized myocardial infarction, Coronary artery disease, Prevalence, Prognosis, Troponin, NT-proBNP, Galectin-3
National Category
Family Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-48240 (URN)978-91-7529-125-3 (ISBN)
Public defence
2016-05-13, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
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Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2016-04-21Bibliographically approved

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