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European Heart Journal 2002 23(13):1011-1020; doi:10.1053/euhj.2001.2969
Copyright © 2002 by the European Society of Cardiology.
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Prognostic value of two-dimensional echocardiography and N-terminal proatrial natriuretic peptide following an acute myocardial infarction. Assessment of baseline values (2–7 days) and changes at 3 months in patients with a preserved systolic function

J.E. Otterstada,f1, M.G. St. John Suttonb, G.S. Froelanda, I. Holmec, T. Skjærped and C. Halle

a Division of Cardiology, Vestfold Central Hospital, Toensberg, Norway
b Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, U.S.A.
c Institute of Medical Statistics, Ullevål Hospital, Oslo, Norway
d Division of Cardiology, University Hospital of Trondheim, Norway
e Research Institute for Internal Medicine, University of Oslo, Norway

revised August 20, 2001; accepted August 22, 2001

Abstract

Aims The purpose of this prospective, observational study was to evaluate the relationship of left ventricular volumes, systolic function and plasma N-terminal proatrial natriuretic peptide (Nt-proANP) to cardiac morbidity and mortality in post-myocardial infarction patients with left ventricular ejection fraction ≥40%.

Methods and Results Two-dimensional echocardiographic recordings and Nt-proANP measurements were obtained in 834 patients who survived acute myocardial infarction. Patients were examined at 2–7 days and 3 months after the index infarction and followed up for 24 months. All measurements of left ventricular volumes, ejection fraction and Nt-proANP were performed in core laboratories. During follow-up 102 patients sustained one or more incidents of the combined primary end-point: cardiac death (n=11), recurrent infarction (n=55) or heart failure requiring hospitalization or treatment with an ACE inhibitor and a diuretic (n=52). Using Cox proportional hazards model, baseline Nt-proANP predicted these events (chi-square 25·3, P<0·0001), while baseline echo volumes and ejection fraction did not. During the subsequent 3–24 month period, 51 patients suffered a primary end-point: cardiac death (n=9), recurrent infarction (n=29), heart failure (n=21). An increase in left ventricular end-systolic volume was the strongest predictor for adverse events (chi-square 19·1, P<0·0001), especially for heart failure. Individual changes in Nt-proANP did not predict cardiac events, whereas both echocardiographic variables and Nt-proANP measured at 3 months had a prognostic impact on subsequent cardiac events (3–24 months).

Conclusions In post-myocardial infarction patients with preserved left ventricular function (left ventricular ejection fraction ≥40%) baseline Nt-proANP, but not echocardiographic left ventricular volumes predicted adverse cardiac events. Early changes in left ventricular volumes and ejection fraction from baseline to 3 months had a further prognostic impact on subsequent events (3–24 months). Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Myocardial infarction, left ventricular remodelling, N-terminal proatrial natriuretic factor, two-dimensional echocardiography

f1 Correspondence: Jan Erik Otterstad, MD, FESC, Division of cardiology, Vestfold Central Hospital, N-3116 Toensberg, Norway.

References

  1. Erlebacher JA, Weiss JL, Kallmen C. Late effects of acute infarct dilatation on heart size: a two-dimensional echocardiographic study. Am J Cardiol. 1982;:1120–1126
  2. Sharpe N, Smith H, Murphy J. Early prevention of left ventricular dysfunction after myocardial infarction with angiotensin-converting-enzyme inhibition. Lancet. 1991;337:872–876[CrossRef][Web of Science][Medline]
  3. Søgaard P, Gøtsche CO, Ravkilde J. Effects of captopril on ischemia and dysfunction of the left ventricle after myocardial infarction. Circulation. 1993;87:1093–1099[Abstract/Free Full Text]
  4. St. John Sutton MG, Pfeffer MA, Plappert T. Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation. 1994;89:68–75[Abstract/Free Full Text]
  5. Lancet. 1994;343:1115–1122[Web of Science][Medline]
  6. Pfeffer MA, St. John Sutton MG. Left ventricular remodelling after myocardial infarction. St. John Sutton MG. Left ventricular remodelling after myocardial infarction. London: Science Press; 1996. p. 1–10
  7. Hall C, Rouleau JL, Moyé LA. N-terminal proatrial natiuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Circulation. 1994;89:1934–1942[Abstract/Free Full Text]
  8. Otterstad JE, Lubsen K, Parker A. Left ventricular remodelling in post-myocardial infarction patients with left ventricular ejection fraction 40–50% vs 25–39%. Influence of nisoldepine treatment? Scand Cardiovasc J. 1999;33:234–241[CrossRef][Web of Science][Medline]
  9. Otterstad JE, Froeland G, St. John Sutton MG. Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and function. Eur Heart J. 1997;18:507–513[Abstract/Free Full Text]
  10. Folland ED, Parisi AF, Moynihan PF. Assessment of left ventricular ejection fraction and volume by real-time two-dimensional echocardiography: a comparison of cineangiographic and radionucleide techniques. Circulation. 1979;60:760–767[Abstract/Free Full Text]
  11. Silverman NH, Ports TA, Snider AR. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons. Circulation. 1980;62:548–557[Free Full Text]
  12. Sundsfjord JA, Thibault G, Larochelle P. Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factors in man. J Clin Endocrinol Metab. 1988;88:605–610
  13. Patten RD, Udelson JE, Konstam MA. Left ventricular dysfunction and heart failure following myocardial infarction: early intervention in high-risk patients. Sharpe N. Heart Failure Management. London: Martin Dunitz Ltd; 2000. p. 183–198
  14. Volpi A, De Vita C, Franzonsi MG. Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis. Results of the GISSI-2 data base. The ad hoc Working Group of the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI)-2 Data Base. Circulation. 1993;88:416–429[Abstract/Free Full Text]
  15. Glanuzzi P, Temporelli PL, Bosimi E. Heterogeneity of left ventricular remodelling after acute myocardial infarction: Results of the Gruppo Italiano per lo Studio della Sopravivenza nell'Infarto Miocardico-3 Echo substudy. Am Heart J. 2001;141:131–138[CrossRef][Web of Science][Medline]
  16. Hole T, Otterstad JE, Home I, Skjaerpe T, Froeland G, St. John Sutton MG. Significant differences in prognostic value of echocardiographic measurements between local investigators and a core laboratory in a follow-up study of patients with acute myocardial infarction (Abstr). Eur J Echocardiography. 2000;1:S20
  17. Vesely DL, Norris JS, Walters JM, Jespersen RR, Baeyens DA. Atrial natriuretic prohormone peptides 1-30, 31-67, and 79-98 vasodilate the aorta. Biochem Phys Res Comm. 1987;148:1540–1548
  18. N Engl J Med. 2000;342:143–153
  19. Otterstad JE, Sleight P. The HOPE study. Comparison with other trials of secondary prevention. Clinical Perspective. Eur Heart J. 2001;22:1307–1310[Abstract/Free Full Text]
  20. Pyörälä K, DeBacker G, Graham I, Poole-Wilson P, Wood D. Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J. 1994;15:1300–1331[Free Full Text]

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