P284 BNP in acute coronary syndrome – correlation with angiographic and hemodynamic findings.
1A.Germing, 2H.Stiegler, 2M.Krieg, 1B.Lemke, 1A.Mügge
1Medizinische Klinik II, Kardiologie/Angiologie, BG-Kliniken Bergmannsheil, Ruhr-Universität, Bochum; 2Institut für Klinische Chemie, Transfusions- und Laboratoriumsmedizin, BG-Kliniken Bergmannsheil, Ruhr-Universität, Bochum.

Background Concentrations of B-type natriuretic peptide (BNP) are elevated in patients with congestive heart failure and predict left ventricular dysfunction. Recent reports have implicated that BNP might be an important marker in myocardial ischemia but as yet only limited data is available. Therefore, we measured BNP concentrations in the early phase of acute coronary syndrome (ACS) and correlated those to angiographic and hemodynamic findings.

Methods BNP was measured immediately prior to angiography by the Triage assay (Biosite Diagnostics) in 129 consecutive patients (76.7% male, 59.5+13.5 years) undergoing urgent coronary angiography for ACS. The definition of ACS based on the standardized risk stratification including symptoms, ECG abnormalities and troponin T. BNP levels were correlated to angiographic findings, left ventricular enddiastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF).

Results In 93% of patients a CAD was detected by angiography. Percutaneous coronary intervention was performed in 79.8% of the patients. Patients with CAD had a higher mean level of BNP (247+331 pg/ml) compared to those without CAD (120+148 pg/ml). BNP correlated with the severity of CAD with lowest concentrations in one-vessel-disease (156+242 pg/ml), highest in three-vessel-disease (381+366 pg/ml; p=0.018). There was a significant correlation between BNP levels and reduced LVEF (<40%: 612+517 pg/ml, >40: 170+243 pg/ml; p<0.001). BNP levels were strongly related to an enlarged left ventricle (463+485 pg/ml in LVEDD > 54 mm; 143+185 pg/ml in LVEDD < 55 mm; p<0.001).

Summary BNP not only correlates with LVEF and LVEDD but also with angiographical severity of CAD during ACS. This underlines the role of BNP as a complementary marker of myocardial ischemia in patients with ACS. Our preliminary data need to be extended to a larger study population with focus on long-term follow-up.