Association of B-type natriuretic peptide with coronary plaque subtypes detected by coronary computed tomography angiography in patients with stable chest pain

  • Yuhai Yang
  • Caiqin Li
  • Lei Zhao
Original Paper


Increased B-type natriuretic peptide (BNP) level has been suggested to improve clinical predictions of coronary events and all-cause mortality. We aimed to analyze the relationship between BNP levels and coronary plaque subtypes as detected by coronary computed tomography angiography (CCTA). 402 subjects undergoing CCTA were enrolled. The relationship between increased levels of BNP and plaque subtypes was tested using multivariable linear and logistic regression analysis. Plaques were categorized into subtypes of calcified, mixed and non-calcified. Coronary plaque was observed in 93 of 402 individuals. The participants were divided into three groups according to their serum BNP levels. Compared to those with low BNP level, subgroup with high BNP level had increased prevalence of all plaque types and mixed calcified arterial plaque (MCAP). Multivariable logistic regression analysis suggested increased BNP level predicted the MCAP. Multivariable logistic regression analysis between the presence of ≥2 plaques and BNP indicated that, subgroup with high BNP level was more likely to have MCAP than low BNP level. Our study suggests that increased BNP level is associated with MCAP detected by CCTA. Increased BNP level provides additional information about coronary artery disease in patients with stable chest pain detected by CCTA.


B-type natriuretic peptide Coronary plaque Mixed calcified arterial plaque Coronary computed tomography angiography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Mihl C, Maas M, Turek J, Seehofnerova A, Leijenaar RT, Kok M, Lobbes MB, Wildberger JE, Das M (2017) Contrast media administration in coronary computed tomography angiography—a systematic review. Rofo. doi: 10.1055/s-0042-121609 PubMedGoogle Scholar
  2. 2.
    De Filippo M, Capasso R (2016) Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) imaging in the assessment of patients presenting with chest pain suspected for acute coronary syndrome. Ann Transl Med 4:255. doi: 10.21037/atm.2016.06.30 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Imori Y, D’Ascenzo F, Gori T, Munzel T, Fabrizio U, Campo G, Cerrato E, Napp LC, Iannaccone M, Ghadri JR, Kazemian E, Binder RK, Jaguszewski M, Csordas A, Capasso P, Biscaglia S, Conrotto F, Varbella F, Garbo R, Gaita F, Erne P, Luscher TF, Moretti C, Frangieh AH, Templin C (2016) Impact of postdilatation on performance of bioresorbable vascular scaffolds in patients with acute coronary syndrome compared with everolimus-eluting stents: a propensity score-matched analysis from a multicenter “real-world” registry. Cardiol J 23:374–383. doi: 10.5603/CJ.a2016.0052 CrossRefPubMedGoogle Scholar
  4. 4.
    Aguiar Rosa S, Ramos R, Marques H, Santos R, Leal C, Casado H, Saraiva M, Figueiredo L, Cruz Ferreira R (2016) Bailout intravenous esmolol for heart rate control in cardiac computed tomography angiography. Rev Port Cardiol 35:673–678. doi: 10.1016/j.repc.2016.07.004 PubMedGoogle Scholar
  5. 5.
    Qureshi W, Blaha MJ, Nasir K, Al-Mallah MH (2013) Gender differences in coronary plaque composition and burden detected in symptomatic patients referred for coronary computed tomographic angiography. Int J Cardiovasc Imaging 29:463–469. doi: 10.1007/s10554-012-0098-1 CrossRefPubMedGoogle Scholar
  6. 6.
    Zeb I, Li D, Nasir K, Malpeso J, Batool A, Flores F, Dailing C, Karlsberg RP, Budoff M (2013) Effect of statin treatment on coronary plaque progression: a serial coronary CT angiography study. Atherosclerosis 231:198–204. doi: 10.1016/j.atherosclerosis.2013.08.019 CrossRefPubMedGoogle Scholar
  7. 7.
    Maalouf R, Bailey S (2016) A review on B-type natriuretic peptide monitoring: assays and biosensors. Heart Fail Rev 21:567–578. doi: 10.1007/s10741-016-9544-9 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Pemberton CJ, Frampton CM, Aldous S, Bailey M, Young J, Troughton R, Than M, Richards M (2016) B-type natriuretic peptide signal peptide (BNPsp) in patients presenting with chest pain. Clin Biochem 49:645–650. doi: 10.1016/j.clinbiochem.2016.02.015 CrossRefPubMedGoogle Scholar
  9. 9.
    Egom EE (2015) BNP and heart failure: preclinical and clinical trial data. J Cardiovasc Transl Res 8:149–157. doi: 10.1007/s12265-015-9619-3 CrossRefPubMedGoogle Scholar
  10. 10.
    Egom EE, Feridooni T, Hotchkiss A, Kruzliak P, Pasumarthi KB (2015) Mechanisms of renal hyporesponsiveness to BNP in heart failure. Can J Physiol Pharmacol 93:399–403. doi: 10.1139/cjpp-2014-0356 CrossRefPubMedGoogle Scholar
  11. 11.
    Precht H, Kitslaar PH, Broersen A, Dijkstra J, Gerke O, Thygesen J, Egstrup K, Lambrechtsen J (2016) Influence of adaptive statistical iterative reconstruction on coronary plaque analysis in coronary computed tomography angiography. J Cardiovasc Comput Tomogr 10:507–516. doi: 10.1016/j.jcct.2016.09.006 CrossRefPubMedGoogle Scholar
  12. 12.
    Cademartiri F, Runza G, Palumbo A, Maffei E, Martini C, McFadden E, Somers P, Knaapen M, Verheye S, Weustink AC, Mollet NR, de Feyter PJ, Hamers R, Bruining N (2010) Lumen enhancement influences absolute noncalcific plaque density on multislice computed tomography coronary angiography: ex-vivo validation and in-vivo demonstration. J Cardiovasc Med (Hagerstown) 11:337–344. doi: 10.2459/JCM.0b013e3283312400 CrossRefGoogle Scholar
  13. 13.
    Aleksova A, Masson S, Maggioni AP, Lucci D, Urso R, Staszewsky L, Ciaffoni S, Cacciatore G, Misuraca G, Gulizia M, Mos L, Proietti G, Minneci C, Latini R, Sinagra G, on the behalf of the CandHeart I (2012) Effects of candesartan on left ventricular function, aldosterone and BNP in chronic heart failure. Cardiovasc Drugs Ther 26:131–143. doi: 10.1007/s10557-012-6370-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Cantinotti M, Law Y, Vittorini S, Crocetti M, Marco M, Murzi B, Clerico A (2014) The potential and limitations of plasma BNP measurement in the diagnosis, prognosis, and management of children with heart failure due to congenital cardiac disease: an update. Heart Fail Rev 19:727–742. doi: 10.1007/s10741-014-9422-2 CrossRefPubMedGoogle Scholar
  15. 15.
    Beltrami M, Palazzuoli A, Ruocco G, Aspromonte N (2016) The predictive value of plasma biomarkers in discharged heart failure patients: the role of plasma BNP. Minerva Cardioangiol 64:147–156PubMedGoogle Scholar
  16. 16.
    Palazzuoli A, Beltrami M, Ruocco G, Franci B, Campagna MS, Nuti R (2016) Diagnostic utility of contemporary echo and BNP assessment in patients with acute heart failure during early hospitalization. Eur J Intern Med 30:43–48. doi: 10.1016/j.ejim.2015.11.031 CrossRefPubMedGoogle Scholar
  17. 17.
    Tang WH, Tong W, Troughton RW, Martin MG, Shrestha K, Borowski A, Jasper S, Hazen SL, Klein AL (2007) Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure. J Am Coll Cardiol 49:2364–2370. doi: 10.1016/j.jacc.2007.02.053 CrossRefPubMedGoogle Scholar
  18. 18.
    Nishikimi T (2012) Do plasma levels of brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) increase in diastolic dysfunction as well as in systolic dysfunction? Circ J 76:2540–2541CrossRefPubMedGoogle Scholar
  19. 19.
    Watanabe E, Arakawa T, Uchiyama T, Tong M, Yasui K, Takeuchi H, Terasawa T, Kodama I, Hishida H (2007) Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure. Heart Rhythm 4:999–1005. doi: 10.1016/j.hrthm.2007.04.019 CrossRefPubMedGoogle Scholar
  20. 20.
    Inoue Y, Kawai M, Minai K, Ogawa K, Nagoshi T, Ogawa T, Yoshimura M (2016) The impact of an inverse correlation between plasma B-type natriuretic peptide levels and insulin resistance on the diabetic condition in patients with heart failure. Metabolism 65:38–47. doi: 10.1016/j.metabol.2015.09.019 CrossRefPubMedGoogle Scholar
  21. 21.
    Yi M, Chun EJ, Lee MS, Lee J, Choi SI (2015) Coronary CT angiography findings based on smoking status: do ex-smokers and never-smokers share a low probability of developing coronary atherosclerosis? Int J Cardiovasc Imaging 31(Suppl 2):169–176. doi: 10.1007/s10554-015-0738-3 CrossRefPubMedGoogle Scholar
  22. 22.
    Rivera JJ, Nasir K, Cox PR, Choi EK, Yoon Y, Cho I, Chun EJ, Choi SI, Blumenthal RS, Chang HJ (2009) Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects. Atherosclerosis 206:451–457. doi: 10.1016/j.atherosclerosis.2009.05.027 CrossRefPubMedGoogle Scholar
  23. 23.
    Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA, Carson SS (2009) The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 169:1961–1965. doi: 10.1001/archinternmed.2009.360 CrossRefPubMedGoogle Scholar
  24. 24.
    Nilsson L, Wieringa WG, Pundziute G, Gjerde M, Engvall J, Swahn E, Jonasson L (2014) Neutrophil/lymphocyte ratio is associated with non-calcified plaque burden in patients with coronary artery disease. PLoS ONE 9:e108183. doi: 10.1371/journal.pone.0108183 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Niemela M, Kervinen K, Jensen JS, Galloe A, Nikus K, Vikman S, Ravkilde J, James S, Aaroe J, Ylitalo A, Helqvist S, Sjogren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Lassen JF, Thuesen L, Nordic PCISG (2006) Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 114:1955–1961. doi: 10.1161/CIRCULATIONAHA.106.664920 CrossRefPubMedGoogle Scholar
  26. 26.
    Hausleiter J, Meyer T, Hadamitzky M, Kastrati A, Martinoff S, Schomig A (2006) Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol 48:312–318. doi: 10.1016/j.jacc.2006.02.064 CrossRefPubMedGoogle Scholar
  27. 27.
    Khalid U, Wruck LM, Quibrera PM, Bozkurt B, Nambi V, Virani SS, Jneid H, Agarwal S, Chang PP, Loehr L, Basra SS, Rosamond W, Ballantyne CM, Deswal A (2017) BNP and obesity in acute decompensated heart failure with preserved vs. reduced ejection fraction: the Atherosclerosis Risk in Communities Surveillance Study. Int J Cardiol 233:61–66. doi: 10.1016/j.ijcard.2017.01.130 CrossRefPubMedGoogle Scholar
  28. 28.
    Maries L, Manitiu I (2013) Diagnostic and prognostic values of B-type natriuretic peptides (BNP) and N-terminal fragment brain natriuretic peptides (NT-pro-BNP). Cardiovasc J Afr 24:286–289. doi: 10.5830/CVJA-2013-055 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Nishikimi T (2012) Clinical significance of BNP as a biomarker for cardiac disease–from a viewpoint of basic science and clinical aspect. Nihon Rinsho 70:774–784PubMedGoogle Scholar
  30. 30.
    Lourenco P, Ribeiro A, Pintalhao M, Cunha FM, Pereira J, Marques P, Vilaca JP, Amorim M, Silva S, Bettencourt P (2017) Prognostic prediction in acute heart failure patients with extreme BNP values. Biomarkers. doi: 10.1080/1354750X.2017.1289243 PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Medical Imaging CenterThe Second Hospital of Shandong UniversityJinanChina
  2. 2.Department of Nuclear MedicineChangle People’s HospitalWeifangChina

Personalised recommendations