The extent of myocardial damage assessed by contrast‐enhanced MRI is a major determinant of N‐BNP concentration after myocardial infarction

Abstract

Aims: To evaluate the relationship between N-terminal Pro-Brain Natriuretic Peptide (N-BNP) level and contrast-enhanced MRI in patients after acute myocardial infarction (MI). Methods: Eighty-two patients were studied. Venous blood samples were obtained 3 days after MI and MRI was performed from 2 to 7 days after MI, with determination of left ventricular function and acquisition of perfusion data after injection of gadolinium-DTPA. First-pass images (FPI) and Delayed contrast-enhanced (CE) images were analyzed using a 17-segment model, and the extent of transmurality was determined by a visual score. Results: Univariate analysis showed that age ( P < 0.001), sex ( P < 0.02), Left Ventricular Ejection Fraction (LVEF) < 45% ( P < 0.002), creatinine ( P < 0.05) and delayed CE-MR images ( P < 0.006) were predictors of a supramedian N-BNP level. FPI was not a predictor in this univariate analysis ( P < 0.078). In a multivariate model, only age, LVEF < 45% and delayed CE-MRI were associated with an increased N-BNP level. Conclusion: After MI, high N-BNP levels are dependent on the LVEF but also on the myocardial infarct size derived from the delayed CE-MR images.

Predictive value of NT-pro BNP after acute myocardial infarction: Relation with acute and chronic infarct size and myocardial function

“…Several studies reported on the role of BNP, and that of NT-pro BNP as prognosis markers for mortality after AMI [31,34] and their predictive value according to their relation with EF and LV remodeling [32,35]. Recently, Cochet et al found correlations between NT-proBNP concentrations on day 3 after AMI and LVEF and infarct size derived from the delayed ce-MR images [36], but they measured NT-pro BNP in a heterogeneous cohort of patients with the whole clinical spectrum of acute coronary syndromes and without long-term monitoring. Some clinical trials suggest that the release kinetics of cardiac markers, especially NT-pro BNP, in patients with STEMI differ from those in non-STEMI-ACS [34].…”

N-terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute ST-elevation myocardial infarction underwent primary percutaneous coronary intervention

“…Cardiogenic shock is the leading cause of death for patients with acute myocardial infarction (MI) and associated with loss of about 40% of the LV myocardium [16,17]. It has been suggested that the magnitude of the increase in NT-pro-BNP after MI reflects not only the size of the necrosis but also the extent of ischemic territory [18,19]. Although we did not measure directly infarct size or biomarker that reflects the extent of myocardial damage, this study revealed that increased NT-proBNP level is associated with a deteriorated left ventricular function and cardiogenic shock requiring IABP.…”

NT-proBNP on admission for early risk stratification in STEMI patients submitted to PCI. Relation with extension of STEMI and inflammatory markers

“…Cochet et al observed that NTproBNP following myocardial infarction appeared associated not only with LV ejection fraction impairment but also with the extent of myocardial damage as assessed by CE-MRI [13].…”

“…With regard to the use of Tn I to estimate infarct size, this factor cannot be considered alone a reliable indicator of infarct size since it is known that reperfusion induces a highly variable release of enzymes [14], whereas ejection factor is widely accepted as a surrogate of myocardial infarct extension [13,15].…”