Association between Natriuretic Peptides and Mortality among Patients Admitted with Myocardial Infarction: A Report from the ACTION Registry®–GWTG™

Scirica, Benjamin M.; Kadakia, Mitul B.; Lemos, James A. de; Roe, Matthew T.; Morrow, David A.; Li, Shuang; Wiviott, Stephen D.; Kontos, Michael C.

doi:10.1373/clinchem.2012.198556

Cited by 18 publications

(16 citation statements)

References 28 publications

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“…Our results expand knowledge of earlier findings of enhanced risk prediction using natriuretic peptides in patients with a recent ACS3, 10, 11, 12 to also include patients with a recent ACS and type 2 diabetes mellitus. This prevalent population has only marginally been studied in this context 37, 38, 39, 40.…”

Section: Discussionsupporting

confidence: 82%

“…Patients admitted with an acute coronary syndrome (ACS) are at increased risk of subsequent cardiovascular events, especially those with type 2 diabetes mellitus,1, 2 who constitute ≈30% of all ACS patients 3. Determining the predictors of death, myocardial infarction (MI), heart failure (HF), and stroke among these patients is important as it assists in identifying the individuals at highest risk of these various outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…However, as the incidences of outcomes differ between patients with HF8 and patients with a recent ACS9 in a stable phase, it is less established how natriuretic peptides are associated with cardiovascular outcomes, especially subsequent MI and stroke, in the latter population 3, 10, 11, 12, 13, 14. Concentrations of natriuretic peptides may be affected by both asymptomatic myocardial ischemia15, 16 and atrial fibrillation,17, 18 which could make BNP and NT‐proBNP relevant as predictors of MI and stroke.…”

Section: Introductionmentioning

confidence: 99%

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Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Wolsk

Claggett

Pfeffer

et al. 2017

JAHA

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BackgroundNatriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B‐type natriuretic peptide (BNP) and N‐terminal prohormone B‐type natriuretic peptide (NT‐proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus.Methods and ResultsPatients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow‐up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/NT‐proBNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT‐proBNP to best risk models. Overall, BNP and NT‐proBNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77–0.82, P<0.001), cardiovascular death (0.77–0.83, P<0.001), and heart failure (0.84–0.87, P<0.001). BNP or NT‐proBNP alone predicted death as well as all other variables combined (0.77 versus 0.77).ConclusionsIn patients with a recent acute coronary syndrome and type 2 diabetes mellitus, BNP and NT‐proBNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Wolsk

Claggett

Pfeffer

et al. 2017

JAHA

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“…NTproBNP predicted the extent of coronary artery disease and ischemia in the patients with stable angina pectoris, thus contributing to the diagnostic process [19] , and was linked to the severity of the aortic valve disease [20] . The recent ACTION Registry-GWTG study [21] reports the measurements of natriuretic peptides from a cohort of almost 30000 patients admitted to hospitals with an acute myocardial infarction. Among these patients without heart failure, natriuretic peptides were strongly and independently associated with the in-hospital mortality, even after adjustments for the severity of presentation.…”

Section: Physiology Of Natriuretic Peptidesmentioning

confidence: 99%

Physiology of natriuretic peptides: The volume overload hypothesis revisited

Arjamaa¹

2014

WJC

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The discovery of the natriuretic peptide system in the early 1980s aroused great interest among clinical cardiologists. The heart was not a mechanical pump alone, but also an endocrine organ that had powerful effects on blood circulation. Natriuretic peptides caused both natriuresis and diuresis, and they responded to a volume overload which caused either stretch or pressure on the heart. As a result, the findings led to the conclusion that the human body had a hormone with effects similar to those of a drug which treats high blood pressure. Later, it became evident that the volume contraction was fortified by extrarenal plasma shift. Here, a hypothesis is presented in which the role of natriuretic peptides is to regulate oxygen transport as the volume contraction leads to hemoconcentration with an increased oxygen-carrying capacity. Wall stress, either chemical or mechanical, changes the oxygen gradient of the myocardium and affects the diffusion of oxygen within a myocyte. In support of this hypothesis, hypoxia-response elements have been found in both the atrial natriuretic peptide and the brain natriuretic peptide genes.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Natriuretic peptides; Hypoxia; Hemoglobin concentration; Volume overload Core tip: A new concept is suggested for the understanding of the physiology of natriuretic peptides. Both chemical and physical challenges will ultimately increase the oxygen consumption of the heart which is the factor regulating the release of natriuretic peptides. Diuresis, natriuresis and plasma shift lead to hemoconcentration and the oxygen transport in human body will be enhanced.Arjamaa O. Physiology of natriuretic peptides: The volume overload hypothesis revisited.

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“…However, impaired heart function was partially restored through the RDN procedure. In addition, the plasma levels of BNP, which is mainly released from the ventricles and is associated with a higher mortality in heart failure [17], were significantly decreased in MI rats with RDN compared with the MI group. These observations were similar to the findings of Hu et al [18,19].…”

Section: Discussionmentioning

confidence: 94%

Renal Denervation Effects on Myocardial Fibrosis and Ventricular Arrhythmias in Rats with Ischemic Cardiomyopathy

Zhang

Chu

et al. 2018

Cell Physiol Biochem

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Background/Aims: To investigate the impact of renal denervation (RDN) on myocardial fibrosis and ventricular arrhythmias (VAs) in rats with ischemic cardiomyopathy. Methods: An ischemic cardiomyopathy model was reproduced with myocardial infarction (MI) in adult Sprague-Dawley male rats. The RDN/Sham-RDN procedure was performed at 2 weeks after MI. Sham-MI and sham-RDN rats served as the control group. At 4 weeks after RDN, programmed electrical stimulation (PES) was used to induce VAs, including ventricular tachycardia and ventricular fibrillation, in all 3 groups (MI+RDN, MI, and control groups). At the end of PES, heart and kidney samples were harvested. Immunofluorescence labeling was used to investigate the distribution of connexin 43 (Cx43) in the infarcted border zone. Masson's trichrome stain was adopted to determine the degree of cardiac fibrosis. Western blotting was performed to identify the expression of transforming growth factor beta 1 (TGF-β1), α-smooth muscle actin (α-SMA), and Cx43. An enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of B-type natriuretic peptide (BNP) and the amino-terminal propeptides of type I and III collagen (PINP and PIIINP, respectively) and the expression level of renal norepinephrine. Results: Compared with the MI group, RDN significantly decreased the inducibility of VAs (MI+RDN 3/8 rats vs. MI 8/9 rats, P < 0.05; control 1/8 rats) with PES, reduced myocardial fibrosis estimated by collagen volume fraction (MI+RDN 31.10 ± 3.97% vs. MI 54.80 ± 16.39%, P < 0.001; control 4.41 ± 0.92% ), suppressed TGF-β1 (P < 0.01) and α-SMA (P < 0.001) levels, and attenuated both PINP (MI+RDN 41.44 ± 10.10 ng/mL vs. MI 95.49 ± 24.83 ng/mL, P < 0.001; control 11.90 ± 4.96 ng/mL) and PIIINP (MI+RDN 82.12 ± 30.79 ng/mL vs. MI 124.60 ± 26.64 ng/mL, P < 0.05; control 64.69 ± 23.84 ng/mL) levels. Moreover, RDN reversed the abnormal myocardial distribution of Cx43 and its reduction by MI damage (P < 0.01). Conclusions: RDN reduced myocardial fibrosis and suppressed VAs in a rat model of ischemic cardiomyopathy.

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Association between Natriuretic Peptides and Mortality among Patients Admitted with Myocardial Infarction: A Report from the ACTION Registry®–GWTG™

Abstract: BACKGROUND:Patients with increased blood concentrations of natriuretic peptides (NPs) have poor cardiovascular outcomes after myocardial infarction (MI). The objectives of this analysis were to evaluate the utilization and the prognostic value of NP in a large, realworld MI cohort.

Cited by 18 publications

References 28 publications

Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

Physiology of natriuretic peptides: The volume overload hypothesis revisited

Renal Denervation Effects on Myocardial Fibrosis and Ventricular Arrhythmias in Rats with Ischemic Cardiomyopathy

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