Usefulness of N-terminal Pro–brain Natriuretic Peptide and Myocardial Perfusion in Asymptomatic Adults (from the Multi-Ethnic Study of Atherosclerosis)

• Published in: The American journal of cardiology Vol. 115; no. 10; pp. 1341 - 1345
• Main Authors: Mitchell, Adam, MD, Misialek, Jeffrey R., MPH, Folsom, Aaron R., MD, MPH, Duprez, Daniel, MD, PhD, Alonso, Alvaro, MD, PhD, Jerosch-Herold, Michael, PhD, Sanchez, Otto A., MD, PhD, Watson, Karol E., MD, Sallam, Tamer, MD, Konety, Suma H., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.05.2015; Elsevier Limited
• Subjects: Adenosine; Age; Aged; Aged, 80 and over; Asymptomatic Diseases - epidemiology; Atherosclerosis; Atherosclerosis - blood; Atherosclerosis - diagnosis; Atherosclerosis - ethnology; Blood pressure; Body mass index; Cardiology; Cardiovascular; Cardiovascular disease; Confidence intervals; Coronary Artery Disease - blood; Coronary Artery Disease - diagnosis; Coronary Artery Disease - ethnology; Coronary Circulation - physiology; Coronary vessels; Cross-Sectional Studies; Demographics; Diabetes; Education; Electrocardiography; Ethnic Groups; Female; Follow-Up Studies; Gender; Glucose; Heart attacks; Heart rate; Humans; Incidence; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Minnesota - epidemiology; Myocardial Perfusion Imaging - methods; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Peptides; Prospective Studies; Protein Precursors; Regression analysis; Risk Factors; Statins; Studies; Minnesota
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.02.040

This study sought to investigate the relation between myocardial perfusion and N-terminal pro-brain natriuretic peptide (NT-proBNP) in asymptomatic adults without overt coronary artery disease. NT-proBNP is a cardiac neurohormone secreted from the ventricles in response to ventricular volume expansion and pressure overload and may also be elevated in the setting of reduced myocardial perfusion. We hypothesized that reduced myocardial perfusion reserve (MPR) would be associated with elevated NT-proBNP in participants free of overt cardiovascular disease. MPR was measured by cardiac magnetic resonance, before and after adenosine infusion, in 184 MESA participants (mean age 60 ± 10.4, 58% white, 42% Hispanic, 44% women) without overt cardiovascular disease. MPR was modeled as hyperemic myocardial blood flow (MBF) adjusted for MBF at rest. A linear regression analysis, adjusted for demographics, established cardiovascular risk factors, left ventricular mass, coronary calcium score, body mass index, and medications, was used to determine the association between MPR and NT-proBNP. Participants with low hyperemic MBF were more likely to be older, male, diabetic, and have higher blood pressure and higher coronary artery calcium score. Mean hyperemic MBF was 3.04 ± 0.829 ml/min/g. MPR was inversely associated with NT-proBNP levels. In a fully adjusted model, every 1-SD decrement in MPR was associated with a 21% increment in NT-proBNP (p = 0.04). In conclusion, MPR is inversely associated with NT-proBNP level in this cross-sectional study of asymptomatic adults free of overt coronary artery disease, suggesting that higher NT-proBNP levels may reflect subclinical myocardial microvascular dysfunction.