Silent myocard ischemia and brain natriuretic peptide relationship in end stage renal failure patients under hemodialysis

Purpose: The mortality rates in end stage renal disease patients areexteremely high compared to general population and cardiovascular diaseases arethe leading cause of death. The purpose of this study was to evaluate the value ofBNP for detecting silent myocardial ischemia which is known to be an importantfactor in the development of adverse cardiovascular complications.Methods: 53 hemodialysis patients with no anginal symptoms wereincluded. The demographic, laboratory and echocardiographic systolic anddiastolic left ventricular functions were recorded. BNP assays were done beforethe second dialysis session of the week. Ambulatory electrocardiographicmonitorisation were done to all patients in order to determine silent myocardialischemia. The patients were grouped according to silent myocardial ischemiadevelopment. The differences between groups, parameters which show correlationwith basal BNP concentrations and independent predictors for the development ofsilent myocardial ischemia were determined. The value of BNP as a screening testfor detection of silent myocardial ischemia in patients with no known coronaryartery disease, was evaluated using receiver operative characteristic curve (ROC).Results: The median age of the participants was 50 (60 % male). Male sexwas significantly more frequent in ischemia group (91 % vs 52 %, p=0,035).Other demographic and echocardiographic parameters were similar in bothgroups. The median BNP concentration was significantly higher in the ischemiagroup (682,7 pg/mL vs 503,2, p= 0,006). Left ventricular mass index (r=0,502,p<0,001) and E/ E? mean (r=0,604, p<0,001) showed significant positivecorrelation with basal BNP concentrations in the whole cohort. Logistic68regression analysis, including possible confounders for BNP concentrations andsilent ischemia development revealed BNP as an independent predictor of silentmyocardial ischemia development both in the whole cohort (OR=1,05, %95 CI:1,009-1,094, p=0,018) and when the patients with known coronary artery diseasewere excluded from the analysis (OR=1,08, %95 CI: 1,006-1,159). ROC analysisin order to determine the BNP?s usefulness as a screening test in patients with noknown coronary artery disease revealed %90 sensitivity and %57 specificity (areaunder the curve=0,773, p=0,006).Result: BNP might be of value in predicting silent myocardial ischemiadetermined with ambulatory electrocardiographic monitorisation in hemodialysispatients.