Broader indications for B-type natriuretic peptide testing in coronary artery disease

Abstract

This editorial refers to ‘B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation’† by R. Bassan et al. , on page 234 and ‘Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the Athero Gene study’‡ by R. Schnabel et al. , on page 241 B-type natriuretic peptide (BNP) is synthesized by cardiac myocytes when left ventricular wall stress increases. After secretion the pro-hormone is cleaved to the biologically active hormone (BNP) and an inactive N-terminal fragment (N-BNP). There is now reliable evidence that measuring the blood level of either BNP or N-BNP improves the ability to diagnose or exclude heart failure as the cause of acute dyspnoea,1 and provides powerful information on mortality risk both in patients with heart failure and in patients admitted to hospital with an acute coronary syndrome.2 Two papers in this issue of the European Heart Journal suggest that indications for BNP testing could be broadened further to include early diagnosis of myocardial infarction in patients with acute chest pain,3 and to risk assessment of patients with stable coronary artery disease.4 Bassan et al. 3 assessed the value of admission BNP for diagnosis of myocardial infarction in patients presenting with chest pain without ST-elevation on the electrocardiogram. The plasma level of BNP on admission was >100 pg/mL in ∼70% of patients subsequently diagnosed with myocardial infarction, while blood levels of creatinine kinase-MB (CK-MB) or troponin I were elevated in only ∼50% of these … *Tel: +64 9 630 9903; fax: +64 9 623 6422. E-mail address : rstewart{at}adhb.govt.nz