Plasma natriuretic peptides as indicators of left ventricular remodeling after myocardial infarction

https://doi.org/10.1016/S0167-5273(98)00026-6Get rights and content

Abstract

To investigate the relationship between natriuretic peptides and left ventricular remodeling after acute myocardial infarction, left ventriculography and blood sampling were performed on admission, after 1 month and after 3 months in 33 patients with acute myocardial infarction (15 anterior and 18 inferior). Plasma atrial and brain natriuretic peptide concentrations at 1 and 3 months were higher than those of controls (P<0.01). Brain natriuretic peptide concentrations correlated with changes in left ventricular end-diastolic volume index after 1 and 3 months (1 month: r=0.57, P=0.003; 3 months: r=0.47, P=0.006). Atrial natriuretic peptide concentrations also correlated with changes in left ventricular end-diastolic volume index after 1 and 3 months (1 month: r=0.40, P=0.02; 3 months: r=0.61, P<0.001). Our results indicate that natriuretic peptide concentrations increase in the chronic phase of acute myocardial infarction and may relate to left ventricular remodeling. Thus, atrial natriuretic peptide as well as brain natriuretic peptide concentrations may be useful biochemical markers in identifying asymptomatic patients at risk for heart failure or sudden death after acute myocardial infarction.

Introduction

Progressive left ventricular remodeling after acute myocardial infarction is serious risk factor for cardiac death [1]. Previous studies have demonstrated that infarct size and persistent occlusion of the infarct-related coronary artery are two important factors that promote progressive ventricular dilatation 2, 3. These remodeling changes begin in the acute period and are progressive and may, occasionally, continue long after [4]. Therefore, early detection of left ventricular remodeling is important in the treatment of patients with acute myocardial infarction. There are several methods of quantifying the left ventricular remodeling such as left ventriculography [1], radionuclide ventriculogram [5], and echocardiography [6]. However, no single `gold-standard' noninvasive method for the evaluation of left ventricular remodeling has been established.

On the other hand, cardiac natriuretic peptides, atrial natriuretic peptide and brain natriuretic peptide are activated in the acute phase of acute myocardial infarction [7], and neurohumoral activation has often been regarded as a marker of compromised hemodynamic function. In addition, recent data suggest that some neurohormones may be prognostic indicators independent of signs of clinical heart failure and hemodynamic variables 8, 9. Omland et al. reported that brain natriuretic peptide provided significant prognostic information in patients after acute myocardial infarction [8]. However, it is not clear whether plasma atrial natriuretic peptide and brain natriuretic peptide levels are increased in the chronic phase of acute myocardial infarction, or whether these peptides correlate with left ventricular remodeling. In the present study, we evaluated the relationship between atrial natriuretic peptide and brain natriuretic peptide concentrations and left ventriculographic parameters in the early and chronic phase of acute myocardial infarction. We assessed the clinical value of neurohumoral evaluation as an indicator of left ventricular remodeling.

Section snippets

Subjects

We studied 33 Japanese patients with acute myocardial infarction (25 men, eight women) aged 40 to 80 years (mean age 59±11 years). A diagnosis of acute myocardial infarction was based on two of the three criteria: (1) typical ischemic chest pain lasting longer than 30 min, (2) electrocardiographic ST-segment elevation of 0.1 mV in 2 contiguous leads, (3) elevation of serum total creatine kinase and its MB isoenzyme to at least twice the upper limit of normal. We excluded patients with a history

Clinical characteristics and natriuretic peptide concentrations

Baseline characteristics are listed in Table 1. Fifteen patients had anterior infarction, and 18 had inferior infarction. Atrial natriuretic peptide and brain natriuretic peptide levels in the age- and sex-matched control subjects were 7±2 pg/ml and 6±2 pg/ml, respectively. Plasma atrial natriuretic peptide concentrations on admission, after 1 month and after 3 months were higher than those of the control group (P<0.05). Plasma brain natriuretic peptide concentrations on admission, after 1

Discussion

The present study demonstrates that atrial natriuretic peptide and brain natriuretic peptide concentrations are increased and correlate with left ventricular dilatation in the chronic phase of acute myocardial infarction. Thus, atrial natriuretic peptide and brain natriuretic peptide may be sensitive and useful biochemical markers of left ventricular remodeling in the chronic phase of acute myocardial infarction.

Acknowledgements

We thank Ms. Yoko Saito for technical assistance and Ms. Hiromi Hosaka for secretarial assistance.

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