Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. Issue 2 (1st February 1999)

• Record Type: Journal Article
• Authors: Richards, A M; Nicholls, M G; Yandle, T G; Ikram, H; Espiner, E A; Turner, J G; Buttimore, R C; Lainchbury, J G; Elliott, J M; Frampton, C; Crozier, I G; Smyth, D W
• Is Part Of: Heart. Volume 81:Issue 2(1999)
• Page Start: 114
• Page End: 120
• Publication Date: 1999-02-01
• Subjects: cardiac natriuretic peptides -- noradrenaline -- myocardial infarction -- heart failure; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.81.2.114
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To determine the relations of plasma levels of brain natriuretic peptide (BNP), atrial natriuretic factor (ANF), N-terminal ANF (N-ANF), cyclic guanosine monophosphate (cGMP; the cardiac peptide second messenger), and plasma catecholamines to left ventricular function and to prognosis in patients admitted with acute myocardial infarction. Design: Plasma hormones and ventricular function (radionuclide ventriculography) were measured 1–4 days after myocardial infarction in 220 patients admitted to a single coronary care unit. Radionuclide scanning was repeated 3–5 months after infarction. Clinical events were recorded over a mean period of 14 months. Results: Both early and late left ventricular ejection fraction (LVEF) were most closely related to plasma BNP ( r = −0.60, n = 220, p < 0.001; and r = −0.53, n = 192, p < 0.001, respectively), followed by ANF, N-ANF, cGMP, and the plasma catecholamines. Early plasma BNP concentrations less than twofold the upper limit of normal (20 pmol/l) had 100% negative predictive value for LVEF < 40% at 3–5 months after infarction. In multivariate analysis incorporating all the neurohormonal factors, only BNP remained independently predictive of LVEF < 40% (p < 0.005). Survival analysis by median levels of candidate predictors identified BNP as the most powerful discriminator for death (p < 0.0001). No early deaths (within 4 months) occurred in patients with plasma BNP concentrations below the group median (27 pmol/l), and over follow up only three of 26 deaths occurred in this subgroup. Of all episodes of left ventricular failure, 85% occurred in patients with plasma BNP above the median (p < 0.001). In multivariate analyses, BNP alone gave additional predictive information beyond sex, age, clinical history, LVEF, and plasma noradrenaline for both subsequent onset of LVF and death. Conclusions: Plasma BNP measured within 1–4 days of acute myocardial infarction is a powerful independent predictor of left ventricular function, heart failure, or death over the subsequent 14 months, and superior to ANF, N-ANF, cGMP, and plasma catecholamines.