NT-proBNP is a superior prognostic marker in coronary artery disease

Brede Alexander Havneraas Kvisvik‘s thesis has compared biochemical and echocardiographic biomarkers with the aim to improve prognostic assessment of cardiovascular events.


  1. NT-proBNP is a superior prognostic marker to high-sensitivity cardiac troponins in patients with non-ST-elevation acute coronary syndrome.
  2. NT-proBNP is also superior to echocardiographic evaluation in risk stratification of patients with stable coronary artery disease.
  3. Mechanical dispersion provides information on cardiovascular risk in the general population.


Thesis: Cardiovascular risk stratification in the general population and patients with coronary artery disease – Clinical studies on novel biochemical and echocardiographic markers
Candidate: Brede Alexander Havneraas Kvisvik
Time: June 18, 2020 at 11:15
Place: Online-based solution, due to the covid-19 situation
Link to university website


(1) High-sensitivity cardiac troponin T and I are less accurate prognostic markers than amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with non-ST-elevation acute coronary syndrome.

The 360 patients in the study were followed for a median of eight years, and 51 died during the follow-up period. NT-proBNP were better at identifying patients at risk of all-cause death, cardiovascular death and a composite end-point of cardiovascular death and hospitalizations due to heart failure or acute myocardial infarction.

(2)  Mechanical dispersion is a better prognostic echocardiographic marker than global longitudinal strain and ejection fraction in patients with stable coronary artery disease. However, NT-proBNP is an even better prognostic marker than all the echocardiographic measures.

This study included 160 patients one year after coronary revascularization. Over the next 8.4 years, 14 of them died and another 15 were hospitalized with acute myocardial infarction or heart failure. Global longitudinal strain and mechanical dispersion correlated with high-sensitivity troponin I and NT-proBNP levels, while ejection fraction did not.

(3) In a general middle-aged population, increased mechanical dispersion is associated with established cardiovascular risk factors. The study consists of 2529 men and women born in 1950 and living in Akershus, the ACE 1950-study. Those with mechanical dispersion values greater than the median were more likely to have coronary artery disease, hypertension, obesity and diabetes.

Even after including echocardiographic measures in the multivariable model, mechanical dispersion was associated with coronary artery disease and hypertension. Systolic and diastolic dysfunction were also linked to increasing mechanical dispersion.


(1) Kvisvik, B., Mørkrid, L., Røsjø, H., Cvancarova, M., Rowe, A. D., Eek, C., Bentz, B., Edvardsen, T., & Gravning, J. (2017). High-sensitivity troponin T vs I in acute coronary syndrome: prediction of significant coronary lesions and long-term prognosis. Clinical Chemistry63(2), 552-562.

(2) Kvisvik, B., Aagaard, E. N., Mørkrid, L., Røsjø, H., Lyngbakken, M., Smedsrud, M. K., Bendz, B., Haugaa, K. H., Edvardsen, T., & Gravning, J. (2019). Mechanical dispersion as a marker of left ventricular dysfunction and prognosis in stable coronary artery disease. The international journal of cardiovascular imaging35(7), 1265-1275.

(3) Aagaard, E. N., Kvisvik, B., Pervez, M. O., Lyngbakken, M. N., Berge, T., Enger, S., Orstad, E. B., Smith, P.,, Omland, T., Tveit, A., Røsjø, H., & Steine, K. (2020). Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study. European Heart Journal-Cardiovascular Imaging21(2), 183-190.

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