Relationship Between the Plasma Levels of Brain Natriuretic Peptide and Left Ventricular Ejection Fraction in Asymptomatic Patients With Previous Myocardial Infarction

Abstract

SUMMARYWhile the usefulness of measuring the plasma levels of brain natriuretic peptide (BNP) in cases with worsening heart failure and severe heart failure has already been established, the benefits of evaluation of this parameter in asymptomatic stable patients with left ventricular dysfunction is still under debate. Left ventricular function was evaluated in 141 ambulatory outpatients with a previous history of myocardial infarction not associated with symptoms of heart failure for at least one year. The plasma BNP level was also determined in these patients for comparative study. No correlation between the plasma level of BNP and EF was noted in the normal-EF group, while a negative correlation between the two parameters was observed in the low-EF group (Y = 0.439 -0.000266X) (R2 = 0.244, P < 0.0001). The sensitivity was 91.5%, specificity 56.3%, positive predictive accuracy value 61.9%, and negative predictive accuracy value 83.8% for a plasma BNP cut-off level of 89.0 pg/mL.The results suggested that it might be meaningful to measure the plasma BNP level, especially in asymptomatic patients with a previous history of myocardial infarction having a low-EF. (Int Heart J 2005; 46: 1007-1014 Key words: Brain natriuretic peptide, Ejection fraction, Myocardial infarction, Ambulatory outpatients BRAIN natriuretic peptide (BNP) is known to be secreted mainly from the myocardium in acute heart failure and chronic heart failure, to show more marked variation in levels than is known for other neurohumoral factors, 1) and to be correlated with indices of left ventricular functions, including pulmonary artery wedge pressure and left ventricular ejection fraction (EF).

Brain Natriuretic Peptide Levels and Cardiac Functional Capacity in Patients With Dyspnea and Isolated Diastolic Dysfunction

“…A study by Watanabe, et al revealed no correlation between BNP levels and normal ejection fraction after myocardial infarction. 15) In the present study, we found no such correlation. However, as already pointed out, all of our patients had normal systolic function, which we considered to be the reason for not finding such a correlation.…”

The Benefits of Repeated Measurements of B-type Natriuretic Peptide in Patients With First ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

“…On the other hand, it is reasonable to assess BNP in asymptomatic patients with a previous history of myocardial infarction and a low ejection fraction. 20) The data obtained in the present study confirm that plasma levels of BNP are elevated in the early stages of AMI, peaking after 24 hours from the onset of symptoms. A worsened prognosis related to the second BNP measurement for the short-term may have important practical implications.…”

Plasma Brain Natriuretic Peptide (BNP) as an Indicator of Left Ventricular Function, Early Outcome and Mechanical Complications after Acute Myocardial Infarction

“…Afterwards, BNP rises as a result of systolic and diastolic dysfunction and increased wall stress of the left ventricle 3–5. There have been several evidences, supporting that variation in plasma BNP level during acute phase of AMI, can be used as a prognostic factor 1.…”