Objective The association between B-type natriuretic peptide (BNP) and coronary artery disease is not fully understood. We assessed whether ischemia per se is a stimulus for BNP secretion.
Setting University Tertiary Hospital
Design Prospective interventional study
Patients 11 patients (55±9 years, LVEF 45±7%) with a non-complicated anterior myocardial infarction (MI) and isolated stenosis of the LAD coronary artery, successfully treated by primary angioplasty.
Interventions 11.0±0.9 days post-MI, the LAD was occluded (20 min) for intracoronary infusion of progenitor cells. Blood samples were obtained from the femoral artery (peripheral circulation, PC) and the coronary sinus (coronary circulation, CC), immediately before and after coronary occlusion.
Main outcome measures BNP (pg/ml) was measured and ischemia biomarkers were monitorized.
Results During coronary occlusion, all patients experienced transitory chest pain and ST-segment dynamic changes. After coronary occlusion, acid lactic levels rose in CC (1.42±0.63 ng/ml to 1.78±0.68 ng/ml, p=0.003). Myoglobin and cTnT did not differ in CC or PC at 24 hours. No differences were found in LVEF (+0.18±2.4%, p=0.86) and motion score index (-0.02±0.06, p=0.37). Before occlusion, BNP levels did not differ significantly in CC vs PC (253±56 vs 179±34, p=0.093). After occlusion, BNP showed a significant increase in CC (vs 332±61, p=0.004), but no change occurred in PC (vs 177±23, p=0.93), and circulating BNP levels were higher in CC vs PC (p=0.008).
Conclusion In response to acute ischemia, BNP levels immediately raise in coronary sinus but not at the peripheral level. BNP release in the coronary effluent may exert local beneficial effects.
- B-type natriuretic peptide
- Coronary artery disease
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