{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:56:48Z","timestamp":1755795408878,"version":"3.44.0"},"reference-count":60,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/100000097","name":"National Center for Research Resources","doi-asserted-by":"publisher","award":["1 UL1 RR024128-01"],"award-info":[{"award-number":["1 UL1 RR024128-01"]}],"id":[{"id":"10.13039\/100000097","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Roche Diagnostics, International"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2018,8,31]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Stress testing is commonly performed in emergency department (ED) patients with suspected acute coronary syndrome (ACS). We hypothesised that changes in N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations from baseline to post-stress testing (stress-delta values) differentiate patients with ischaemic stress tests from controls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled 320 adult patients with suspected ACS in an ED-based observation unit who were undergoing exercise stress echocardiography. We measured plasma NT-proBNP concentrations at baseline and at 2 and 4 \u2009hours post-stress and compared stress-delta NT-proBNP between patients with abnormal stress tests versus controls using non-parametric statistics (Wilcoxon test) due to skew. We calculated the diagnostic test characteristics of stress-delta NT-proBNP for myocardial ischaemia on imaging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 320 participants, the median age was 51 (IQR 44\u201359) years, 147 (45.9%) were men, and 122 (38.1%) were African\u2013American. Twenty-six (8.1%) had myocardial ischaemia. Static and stress-deltas NT-proBNP differed at all time points between groups. The median stress-deltas at 2 \u2009hours were 10.4 (IQR 6.0\u201351.7) ng\/L vs 1.7 (IQR \u22120.4 to 8.7) ng\/L, and at 4 \u2009hours were 14.8 (IQR 5.0\u201322.3) ng\/L vs 1.0 (\u22122.0 to 10.3) ng\/L for patients with ischaemia versus those without. Areas under the receiver operating curves were 0.716 and 0.719 for 2-hour and 4-hour stress-deltas, respectively. After adjusting for baseline NT-proBNP levels, the 4-hour stress-delta NT-proBNP remained significantly different between the groups (p=0.009).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Among patients with ischaemic stress tests, static and 4-hour stress-delta NT-proBNP values were significantly higher. Further study is needed to determine if stress-delta NT-proBNP is a useful adjunct to stress testing.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2018-000847","type":"journal-article","created":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T09:45:38Z","timestamp":1538991938000},"page":"e000847","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Provocative biomarker stress test: stress-delta N-terminal pro-B type natriuretic peptide"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9822-5595","authenticated-orcid":false,"given":"Alexander T","family":"Limkakeng Jr","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J Clancy","family":"Leahy","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S Michelle","family":"Griffin","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuliya","family":"Lokhnygina","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Jaffa","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert H","family":"Christenson","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Maryland 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admission NT-proBNP increase the prognostic accuracy of GRACE risk score in the prediction of short-term mortality after acute coronary syndromes?","volume":"11","author":"Tim\u00f3teo","year":"2009","journal-title":"Acute Card Care"},{"key":"2025081711183167000_5.2.e000847.58","first-page":"1756","article-title":"Testing of low-risk patients presenting to the emergency department with chest pain","volume":"122","author":"Amsterdam","year":"2010","journal-title":"A Scientific Statement From the American Heart Association"},{"key":"2025081711183167000_5.2.e000847.59","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00470.x"},{"key":"2025081711183167000_5.2.e000847.60","unstructured":"Holly J , Fuller M , Hamilton D , et al . 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