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Profile of plasma N-terminal proBNP following acute myocardial infarction. Correlation with left ventricular systolic dysfunction

S Talwar, I.B Squire, P.F Downie, A.M Mccullough, M.C Campton, J.E Davies, D.B Barnett, L.L Ng
DOI: http://dx.doi.org/10.1053/euhj.1999.2045 1514-1521 First published online: 2 September 2000

Abstract

Aims The aims of this study were to describe the temporal pattern of plasma N-terminal pro-brain natriuretic peptide, to examine the optimum time of sampling and to compare plasma N-terminal pro-brain natriuretic peptide to clinical criteria in terms of identification of impaired left ventricular systolic function following acute myocardial infarction.

Methods and Results Measurements of N-terminal pro-brain natriuretic peptide were made in 60 patients at 14–48h, 49–72h, 73–120h, 121–192h following myocardial infarction and at 6 weeks in survivors. Left ventricular wall motion index was assessed during hospitalization (WMI-1) and at 6 weeks (WMI-2). N-terminal pro-brain natriuretic peptide levels were elevated at all time points, to a greater extent in anterior compared to inferior infarction (P<0·05). A biphasic profile of plasma concentration was observed in anterior infarction with peaks at 14–48h and 121–192h. This was sustained at 6 weeks. N-terminal pro- brain natriuretic peptide at 73–120h was the best independent predictor of WMI-1 (P<0·005). N-terminal pro-brain natriuretic peptide was higher at all times in patients who received ACE inhibitor therapy compared to those who did not (P<0·005). N-terminal pro-brain natriuretic peptide at 73–120h (R2=17·7%, P=0·005) and previous myocardial infarction (R2=5·3%, P<0·05) were independent predictors of poor outcome (WMI-2 ≤1·2 or death by 6 weeks).

Conclusions A biphasic pattern of plasma N-terminal pro-brain natriuretic peptide is seen after anterior myocardial infarction. Plasma level is strongly correlated to wall motion index soon after and remote from acute myocardial infarction. Plasma N-terminal pro-brain natriuretic peptide measured later in hospitalization better predicts poor outcome following myocardial infarction than when it is measured in the immediate post infarction period.

  • Brain natriuretic peptide, neurohormones, acute myocardial infarction, left ventricular systolic dysfunction