N-Terminal Pro-Brain Natriuretic Peptide Level is Associated With Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome

The Role of N-Terminal-Pro-B-Type Natriuretic Peptide (NT-proBNP) and High-Sensitivity Troponin T (Hs-Troponin T) in the Evaluation of the Syntax Score in Patients With Acute Coronary Syndrome

Background N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is used to diagnose acute and chronic heart failure, but many studies show a strong and independent correlation between NT-proBNP serum levels and the severity and number of coronary artery damage. Meanwhile, the serum of high-sensitivity Troponin T (hs-Troponin T) has a very high prognostic value for the degree of coronary artery damage in patients with acute coronary syndrome. The SYNTAX score was developed to better predict the risks of percutaneous or surgical revascularization by considering the functional impact of the coronary circulation with all of its anatomic components, such as the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. Therefore, we conducted this study to understand the role of NT-proBNP and hs-troponin T in SYNTAX score evaluation in patients with acute coronary syndrome. Methodology A cross-sectional descriptive study of 86 patients diagnosed with acute coronary syndrome with indications for coronary angiography and intervention in the Department of Emergency and Interventional Cardiology, Cardiovascular Center, Hue Central Hospital, was conducted from June 2020 to May 2022. Results The mean age was 66.94 ± 10.61 years. The concentrations of NT-proBNP and hs-Troponin T in our study were 1115.9 ± 1623.3 pg/mL and 0.86 ± 1.55 ng/mL, respectively. The mean SYNTAX score in the study was 16.5 ± 7.5. There was a positive moderate correlation between the mean levels of NT-proBNP and the degree of coronary artery damage, as indicated by the SYNTAX score (P < 0.01, rho = +0.453). Conversely, there was a weak positive correlation between hs-Troponin T concentrations and the severity of coronary artery disease, based on the SYNTAX score (P < 0.01, rho = +0.387). The area under the curve (AUC) of the hs-Troponin T concentration value was 0.701, using a cutoff point of 0.109 ng/mL for hs-Troponin T concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 76% and a specificity of 59%. In comparison, the AUC of the NT-proBNP concentration value was 0.75, utilizing a cutoff point of 1120.5 pg/mL for NT-proBNP concentration. This predicted the intermediate and high SYNTAX scores, with a sensitivity of 60% and a specificity of 80.3%. Conclusions The levels of NT-proBNP had a positive moderate correlation with the degree of coronary artery damage according to the SYNTAX score in patients with acute coronary syndrome. Hs-Troponin T levels of 0.109 ng/mL had higher sensitivity (76%) but lower specificity (59%) in predicting intermediate and high SYNTAX scores in patients with acute coronary syndromes than those of NT-proBNP levels of 1120.5 pg/mL, with a sensitivity of 60% and a specificity of 80.3%.

Angiopoietin-2 provides no incremental predictive value for the presence of obstructive coronary artery disease over N-terminal pro-brain natriuretic peptide

BACKGROUND

Using circulating biomarkers as a noninvasive method to assist the evaluation of coronary artery disease (CAD) is beneficial for reducing the unnecessary diagnostic cardiac catheterization. This study aimed to assess the predictive role of angiopoietin-2 (Ang-2) for the presence of obstructive coronary stenosis as compared with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with symptoms of CAD.

METHODS

The study enrolled 222 consecutive symptomatic patients who underwent elective diagnostic cardiac catheterization from July to December 2018. Blood samples were collected in the first morning after admission. The severity of coronary stenosis was assessed by coronary angiography. The obstructive CAD was defined as stenosis ≥50% of the left main coronary artery or stenosis ≥70% of a major epicardial vessel (left anterior descending artery, left circumflex artery and right coronary artery).

RESULTS

Patients with obstructive CAD (n = 120) had significantly higher levels of Ang-2 and NT-proBNP compared with those without. In multivariable regression analysis, only NT-proBNP levels were independently associated with Ang-2 levels. NT-proBNP was superior to Ang-2 as a predictor for the presence of obstructive CAD (NT-proBNP, area under curve [AUC] = 0.733, vs Ang-2, AUC = 0.626, P = 0.004). In multiple logistic regression analysis, NT-proBNP, but not Ang-2, was the independent predictor of obstructive CAD. The combination of Ang-2 with NT-proBNP did not provide the incremental value over NT-proBNP alone.

CONCLUSION

Serum Ang-2 levels are associated with NT-proBNP levels in patients suspected for CAD. NT-proBNP is superior to Ang-2 as a predictor for the presence of obstructive CAD. However, Ang-2 does not further increase diagnostic accuracy on top of NT-proBNP.

Predictive value of N-terminal-Pro brain natriuretic peptide in the detection of coronary artery disease in patients with positive myocardial perfusion imaging

Background: N-terminal pro-brain natriuretic peptide (NT-ProBNP) increases during myocardial ischemia and has a potential for the diagnosis of patients with coronary artery disease (CAD). We aimed to determine the incremental diagnostic value of NT-ProBNP in the selection of patients with positive myocardial perfusion imaging (MPI) for coronary angiography. We also tested the association between the level of NT-ProBNP and severity of CAD based on the vessel score and Gensini score.

Methods: In this cross-sectional study, stable angina patients with positive MPI who were assessed by coronary angiography in Imam Khomeini Hospitalwere enrolled. After the collection of demographic and clinical data, NT-ProBNP was measured in all patients on the day of coronary angiography, and its association with the presence of CAD, vessel score and Gensini score was tested.

Results: We enrolled 170 patients (mean age61.2±10.1 years, 86 males (50.6%)). Seventy-two (42.3%) patients had at least one stenotic vessel. NT-Pro BNP was significantly higher in the CAD-positive group (OR=1.01, 95% CI: 1.00-1.02; p=0.008) and could independently predict the presence of CAD at a cut-off point of 69.5, with a sensitivity of 55.6%, specificity of 82.5% and diagnostic accuracy of 61.7%. The Gensini score had a modest correlation with NT-Pro BNP (r=0.60, p<0.001). The combination of MPI result and NT-Pro BNP could predict the presence of CAD (OR=14.57, 95% CI: 4.28, 49.56; p<0.001).

Conclusion: Serum level of NT-Pro BNP alone and its combination with the results of MPI can significantly predict the presence of CAD and therefore, highlights the need for performing coronary angiography.

Clinical SYNTAX Score - a good predictor for renal artery stenosis in acute myocardial infarction patients: analysis from the REN-ACS trial

INTRODUCTION

In ST-elevation myocardial infarction (STEMI) patients, multisite artery disease represents a serious issue influencing evolution, outcomes and prognosis. We evaluated for the first time the power of the Myocardial Infarction SYNTAX Score (MI SS) and Clinical SYNTAX Score (MI CSS) as predictors for renal artery stenosis (RAS) in STEMI. We also stratified the study population according to the two scores, and identified the variables correlated with the higher score.

MATERIAL AND METHODS

We used data from the REN-ACS study, which included 181 consecutive patients prospectively investigated for presence of RAS (through renal angiography), arterial stiffness (carotid-femoral pulse wave velocity, cf-PWV) and hydration status (bioimpedance). MI SS and CSS were computed.

RESULTS

Multivariate regressions indicated that the independent variables correlated with MI SS were left ventricular ejection fraction < 40%, significant RAS (> 50%, defined as RAS+), history of heart failure, and multivascular coronary disease (CAD, p < 0.03 for each), while those correlated with MI CSS were RAS+, cf-PWV, history of CAD, multivascular CAD, cholesterol, and total body water (p < 0.02 for each). In order to evaluate the ability to predict RAS+ we generated receiver operating characteristics and areas under curves, and the Youden index for MI SS and CSS.

CONCLUSIONS

Both scores correlated with extensive atherosclerotic disease and presence of RAS+. A lower CSS proved to be a good predictor for exclusion of RAS+, with high specificity (85%) and negative predictive value (92%), and fair sensitivity (60%). We aim to further pursue this line of research and design a better predictor for RAS, with the inclusion of a novel biomarker in order to increase sensitivity.