Sustained elevation of plasma brain natriuretic peptide levels associated with progressive ventricular remodelling after acute myocardial infarction

Abstract

Previous studies have shown that levels of plasma brain natriuretic peptide (BNP) increase in an early phase of acute myocardial infarction. However, the relations between plasma BNP levels and left ventricular remodelling, which occurs long after acute myocardial infarction, are not fully understood. Venous plasma BNP levels were measured 2, 7, 14, 30, 90 and 180 days after the onset of acute myocardial infarction in 21 patients. Left ventricular end-diastolic volume index (EDVI, ml/m2) in acute (5 days) and chronic (6 months) phases were assessed by electron-beam computed tomography using Simpson's method. The remodelling group (n=9) was defined by an increase in EDVI >/=5 ml/m2 relative to the baseline value. Plasma BNP levels on days 2, 7, 14, 30 and 90 were significantly higher in the remodelling group than in the non-remodelling group (n=12, P<0.05). Sustained elevation of plasma BNP levels was noted from day 2 (61+/-12 pmol/l) to day 90 (55+/-12 pmol/l) and significantly decreased on day 180 (24+/-3 pmol/l) in the remodelling group. In contrast, plasma BNP levels significantly decreased from day 2 (25+/-4 pmol/l) to day 90 (9+/-1 pmol/l) and reached a steady level thereafter in the non-remodelling group. Plasma BNP levels on day 7 correlated positively with an increase in EDVI (r=0.70, P<0.001) from the acute to chronic phase. More importantly, the sustained elevation of plasma BNP (percentage decrease smaller than 25%) from day 30 to day 90 identified patients in the remodelling group with a sensitivity of 100% and a specificity of 83%. In conclusion, not only the high levels of plasma BNP in an acute phase, but also the sustained elevation of plasma BNP in a chronic phase, may be associated with progressive ventricular remodelling occurring long after acute myocardial infarction.

Influence of aerobic exercise training on left ventricular remodeling and neurohumoral response in patients with myocardial infarction

“…Giallauria et al [21,28], showed a decrease of NT-proBNP circulating levels after three months of moderateintensity aerobic training, in patients with ventricular dysfunction after MI. Our data show that moderate-intensity aerobic training does not interfere with the natural course of NT-proBNP plasma level decrease, which usually occurs in the context of MI, associated to VR, as reported by Nagaya et al [29].…”

B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease

“…Finally, it is possible that myocardial infarction is simply an initial trigger for the release of BNP, as has been observed in other settings. [22][23][24][25] The elevation of BNP in outpatients with inducible ischemia has implications for the use of BNP as a diagnostic test for systolic dysfunction. Many (including the European Society of Cardiology) have proposed that BNP should be used as a first-line test for patients with symptoms suggestive of ventricular dysfunction, particularly high-risk patients such as those with coronary disease.…”

Plasma C‐reactive protein predicts left ventricular remodeling and function after a first acute anterior wall myocardial infarction treated with coronary angioplasty: Comparison with brain natriuretic peptide

“…We also measured plasma brain natriuretic peptide (BNP) levels as the referential serological indicator of LV dysfunction, 17,18 long-term prognosis, [19][20][21] and LV remodeling after MI. [21][22][23] …”