Korean Circ J.  2013 Mar;43(3):168-173. 10.4070/kcj.2013.43.3.168.

C-Type Natriuretic Peptide as a Surrogate Marker in Variant Angina Pectoris

• Lee DH
• Youn HJ
• Choi YS
• Lee JM
• Park CS
• Jung HO
• Jeon HK
• Lee MY

• KMID: 2224960
• DOI: http://doi.org/10.4070/kcj.2013.43.3.168

Abstract

BACKGROUND AND OBJECTIVES
The purpose of this study was to assess the value of C-type natriuretic peptide (CNP) as a surrogate marker for detection of coronary artery spasm in variant angina pectoris (VAP).
SUBJECTS AND METHODS
Sixty-six patients (mean age: 51+/-11 years, M : F=40 : 26) who underwent coronary angiography on suspicion of angina and who were diagnosed with VAP by the acetylcholine-induced spasm provocation test (SPT) were enrolled and divided into a SPT (-) group (n=23) and a SPT (+) group (n=43). Concentrations of CNP and other markers were determined by immunoassay in both groups.
RESULTS
Plasma CNP and creatine kinase myoglobin band (CK-MB) concentrations were significantly increased in the SPT (+) group relative to the SPT (-) group (CNP, 5.268+/-1.800 pg/mL vs. 3.342+/-1.150 pg/mL, p=0.002; CK-MB, 2.54+/-1.03 ng/dL vs. 1.86+/-0.96 ng/dL, p=0.019, respectively) while plasma high sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT pro-BNP) concentrations were not significantly different between the SPT (-) group and SPT (+) group (hs-CRP, 2.76+/-4.99 mg/L vs. 3.13+/-4.88 mg/L, p=0.789; NT pro-BNP, 49+/-47 pg/mL vs. 57+/-63 pg/mL, p=0.818, respectively). Plasma CNP concentration was independently associated with the VAP via SPT {odds ratio: 2.014 (95% confidence interval: 1.016-3.992), p=0.045}. A CNP cut-off value of 4.096 pg/mL was found to have a sensitivity of 68.2% and a specificity of 40.0% for predicting the probability of VAP via SPT.
CONCLUSION
Increased plasma CNP concentration in patients with VAP may have an impact on the regulation of endothelial function in accordance with the progression of atherosclerosis. Further analysis is warranted to develop clinical applications of this finding.

Keyword

Natriuretic peptide, C-type; Angina pectoris, variant; Endothelium; Acetylcholine

MeSH Terms

Acetylcholine
Angina Pectoris, Variant
Atherosclerosis
Biomarkers
C-Reactive Protein
Coronary Angiography
Coronary Vessels
Creatine Kinase
Endothelium
Humans
Immunoassay
Myoglobin
Natriuretic Peptide, C-Type
Plasma
Sensitivity and Specificity
Spasm
Acetylcholine
C-Reactive Protein
Creatine Kinase
Myoglobin
Natriuretic Peptide, C-Type

Figure

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  Fig. 1 Difference in CNP levels between the SPT (-) group and the SPT (+) group. CNP: C-type natriuretic peptide, SPT: spasm provocation test.

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  Fig. 2 ROC curve. A cut-off value of CNP of 4.096 pg/mL shows a sensitivity of 86.4% and a specificity of 50.0% for predicting the probability of the presence of VAP via acetylcholine-induced SPT. ROC: receiver operating characteristics, AUC: area under curve, CI: confidence interval, CNP: C-type natriuretic peptide, VAP: variant angina pectoris, SPT: spasm provocation test.

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