Copyright © 2002 by the European Society of Cardiology.
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
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.
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