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BNP as a Biomarker of Cardiac Ischemia
B-type natriuretic Peptide signal Peptide circulates in human blood: evaluation as a potential biomarker of cardiac ischemia.
Circulation. 2010 Jul 20;122(3):255-64.
Siriwardena M, et al
Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
Abstract
BACKGROUND: The diagnosis of cardiac necrosis such as myocardial infarction can be difficult and relies on the use of circulating protein markers like troponin.
However, there is a clear need to identify circulating, specific biomarkers that can detect cardiac ischemia without necrosis.
METHODS AND RESULTS: Using specific immunoassay and tandem mass spectrometry, we show that a fragment derived from the signal peptide of B-type natriuretic peptide (BNPsp) not only is detectable in cytosolic extracts of explant human heart tissue but also is secreted from the heart into the circulation of healthy individuals.
Furthermore, plasma levels of BNPsp in patients with documented acute ST-elevation myocardial infarction (n=25) rise to peak values ( approximately 3 times higher than the 99th percentile of the normal range) significantly earlier than the currently used biomarkers myoglobin, creatine kinase-MB, and troponin.
Preliminary receiver-operating characteristic curve analysis comparing BNPsp concentrations in ST-elevation myocardial infarction patients and other patient groups was positive (area under the curve=0.97; P<0.001), suggesting that further, more rigorous studies in heterogeneous chest pain patient cohorts are warranted.
CONCLUSIONS: Our results demonstrate for the first time that BNPsp exists as a distinct entity in the human circulation and could serve as a new class of circulating biomarker with the potential to accelerate the clinical diagnosis of cardiac ischemia and myocardial infarction.
Clinical Trial Registration- URL: http://www.anzctr.org.au. Unique identifier: ACTRN12609000040268.
Featured Angina| Acute Coronary Syndrome and Heart Disease Interviews
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Author Interview: Claes Held MD
Associate professor at Uppsala Clinical Research Center and the
Cardiology department at Uppsala University Hospital in Sweden
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Publication:
Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study
Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432
2012 doi:10.1093/eurheartj/ehr432
Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf
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What are the main findings of the study?
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The main findings are he following:
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It is well known that physical inactivity is a risk factor for developing cardiovascular disease.
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Our study shows that being physically active reduces the risk of having a heart attack.
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Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries.
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We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %.
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We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.
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Were any of the findings unexpected?
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We looked at the relationship between physical activity both at work and during leisure time.
A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did.
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What should clinicians and patients take away from this study?
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The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines.
This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away.
All PA does a good job for the heart as compared to not doing anything at all!
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What recommendations do you have for cardiology health care providers as a result of your study?
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It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true.
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Abstract
Background— Despite data showing the benefits of implantable cardioverter-defibrillator (ICD) insertion for primary prevention in populations at risk for sudden death, professional society guidelines recommending primary prevention, and recognition by payers of the clinical value of ICDs in these populations, ICDs for primary prevention remain underused. We sought to determine whether implementing a screening tool would increase appropriate identification of patients showing clinical evidence of ICD benefit and prompt referral to an electrophysiologist for ICD implantation.
Methods and Results— Screening tools were affixed to medical records for patients seen in 2 outpatient cardiology offices that queried ejection fraction and whether referral to an electrophysiologist was made (N=6632).
The number of appropriate referrals in the screening period were compared with analogous data collected before implementation of the screening tool (control period) through retrospective record review (n=3606). Significantly more eligible patients were offered referral during the screening period than during the control period at both sites, 80% (8/10 eligible) versus 33% (5/15) at site 1 (P<0.02) and 100% (44/44) versus 60% (21/35) at site 2 (P<0.001). Of all patients offered referral, 41% (32/78) accepted.
Conclusions— The use of a screening tool increases referral to electrophysiology for patients in whom placement of an ICD confers the benefit of sudden cardiac death primary prevention. Barriers to referral include both physician and patient factors. Verification of these findings on a larger scale as well as studies defining the foundation of these barriers may further improve use of ICDs in patients for whom their mortality benefit is well described.
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Amazon.com 's Editorial Reviews
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Amazon.com Editorial Review:
Philips HeartStart Home Defibrillator (AED)
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When sudden cardiac arrest (SCA) strikes, the electrical system of the heart short circuits, causing the heart to quiver rather than pump in a normal rhythm. It typically results in the abnormal heart rhythm know as ventricular fibrillation (VF). It usually happens without warning and the majority of people have no previously recognized symptoms of heart disease. And it most often happens at home. For the best chance of survival from SCA caused by VF, a defibrillator should be used within 5 minutes. Yet, less than 1 in 20 people survive largely because a defibrillator does not arrive in time.
Just as seat belts or airbags do not save every life in a traffic accident, a defibrillator will not save every person who suffers a sudden cardiac arrest. Yet many lives could be saved if more people could be reached more quickly.
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