Acute changes in N-terminal pro-brain natriuretic peptide induced by dobutamine stress echocardiography.

Aims: Aim of the study was to determine the effect of dobutamine stress echocardiography (DSE)-induced ischemia on circulating levels of N-terminal fragment of B-type natriuretic peptide (NT-pro-BNP). Methods and results: One hundred and twenty-eight patients underwent DSE for the evaluation of known or suspected coronary artery disease. NT-pro-BNP levels were measured before and 1 h after completion of DSE. NT-pro-BNP levels were similar before and after DSE regardless of whether patients had (123 +/- 101.8 vs. 124.2 +/- 108.3, p = NS) or did not have inducible ischemia (96.5 +/- 70.5 vs. 100.5 +/- 71.1, p = NS). Patients with inducible myocardial ischemia had no different NT-pro-BNP levels compared to patients without inducible ischemia both before (123 +/- 101.8 vs. 96.5 +/- 70 pg/ml, p = 0.37) and after DSE (124.2 +/- 108.3 vs. 100.5 +/- 71.1 pg/ml, p = 0.55). Patients with severe inducible ischemia had significantly higher NT-pro-BNP levels compared to patients with mild or moderate inducible ischemia and patients without inducible ischemia, both before (208.5 +/- 125.5 vs. 96 +/- 78.9 vs. 96.5 +/- 70 pg/ml, p = 0.017 and p = 0.025, respectively) and after DSE (212.5 +/- 138.1 vs. 94.8 +/- 81.1 vs. 100. 5 +/- 71.1 pg/ml, p = 0.015 and p = 0.023, respectively). NT-pro-BNP levels before DSE could be independently predicted by age (p < 0.0001), presence of diabetes mellitus (p = 0.002), and ejection fraction (p = 0.005), but not DSE inducible ischemia. Conclusion: NT-pro-BNP is not affected by DSE-induced ischemia and cannot be used in clinical practice to improve diagnostic accuracy of DSE. (C) 2006 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.