Reduction in plasma concentrations of N terminal pro B type natriuretic peptide following percutaneous coronary intervention

Abstract

Btype natriuretic peptide (BNP) and its pro-peptide N terminal fragment (NTproBNP) are raised in conditions associated with abnormal ventricular structure and function and are independent predictors of survival in diverse clinical settings. Patients without raised baseline plasma BNP demonstrate an early, transient increase in concentrations following percutaneous coronary intervention (PCI), 1 but longer term effects are unknown. Potential benefits of PCI on ventricular remodelling are likely to be greatest in patients with raised baseline plasma BNP concentrations, reflecting increased wall stress or ongoing ischaemia. We hypothesised that in patients with stable coronary disease and an elevated baseline NTproBNP, successful PCI would result in a significant reduction in the plasma concentration. METHODSThe study population was recruited from a larger prospective study of risk factors for coronary in-stent restenosis.2 To define an elevated baseline value, NTproBNP was measured in a group of 30 healthy volunteers of similar age and sex distribution (mean age 50 years, 83% male) to the patient group who had no history or clinical signs of cardiovascular disease, and underwent comprehensive non-invasive testing to exclude cardiac pathology. The 90th centile was selected as the cut-off value to define raised NTproBNP, corresponding to an NT proBNP concentration of .75 fmol/ml. Local ethics committee approval was obtained and all subjects gave written informed consent.Twenty eight patients with stable angina and raised baseline NTproBNP, undergoing elective, single native vessel stenting to de novo lesions, were included in the PCI group. Blood was drawn before intervention, and then 1, 6, and 24 hours after the procedure. A final sample was obtained at six months follow up. The control group consisted of 13 patients with stable angina and elevated baseline plasma NTproBNP who underwent coronary angiography without subsequent PCI. In these patients bloods were drawn at baseline, 1, 6, and 24 hours, and 7 days post-angiography. Data were also available on a further 19 patients undergoing elective stenting in whom baseline NTproBNP was not raised (that is ( 75 fmol/ml).NTproBNP was analysed by immunoluminometric assay. NTproBNP concentrations are presented as median and interquartile ranges, and were log transformed for analysis. RESULTSClinical characteristics were similar in the PCI and control groups (table 1). Ventricular function at baseline was assessed in 32 of the 41 patients and clinical heart failure was an exclusion criterion for the main study; 17/32 had normal function, 12/32 had moderate dysfunction, and 3/32 had severe dysfunction. NTproBNP concentrations did not vary according to category of left ventricular function.Baseline NTproBNP concentration was 257 (170-771) fmol/ml in the PCI group and 188 (106-550) fmol/l in the control group (p = 0.5). In the PCI group plasma NTproBNP concentrations decreased over time (analysis of variance (ANOVA) p , 0.0001). Concentrations at 1 hour (281 (192-721) fmol...

NT-proANP and NT-proBNP circulating levels as predictors of cardiovascular outcome following coronary stent implantation

“…Post-PCI BNP levels behaved as an independent predictor of MACEs over the subsequent 12 months of follow up [22]. Interestingly, additional studies described a drop of NT-proBNP levels following either PCI or surgical revascularization, although no prognostic implications were explored in that context [23].…”

Plasma ProBNP Is Not a Specific Marker for Transient Myocardial Ischemia

“…They demonstrated a significant decrease in plasma proBNP levels at 24 h post-intervention compared to baseline levels. They speculated that the potential reasons for decrease in proBNP level may be due to decrease in ischemic burden or changes in LV function [ 27 ]. McClure et al studied proBNP levels in 26 patients with LAD stenosis and normal baseline LV function undergoing PCI.…”

A new use for B-type natriuretic peptide: to detect myocardial ischaemia in non-heart failure patients

“…Studies of percutaneous coronary intervention also support this idea, since BNP increases transiently during balloon inflation (when ischaemia occurs), and later falls when the ischaemia is resolved. 31,32 Furthermore, a recent study by McClure et al 33 in patients with stable angina demonstrated a reduction in N-BNP concentration when measured 8 weeks following percutaneous coronary revascularisation of LAD stenosis.…”