Document Detail


N-terminal probrain natriuretic peptide predicts adverse outcomes in acute-myocardial infarction even with preserved left ventricular ejection fraction.
MedLine Citation:
PMID:  18989058     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Risk stratification of patients with acute myocardial infarction is based on various clinical, biochemical or electrocardiographic parameters. There is emerging evidence that N-terminal probrain natriuretic peptides (NT-proBNP) possess characteristics of an ideal biomarker. In this study we looked into the role of NT-proBNP in risk stratification and prediction of short-term events in patients presenting with acute myocardial infarction (MI) and having preserved left ventricular functions as assessed by ejection fraction (EF) on echocardiography. METHODS AND RESULTS: Of a total of 250 consecutive patients admitted with a diagnosis of acute ST segment elevation myocardial infarction, 84 patients were found to have ejection fraction greater than 50% (44 with anterior MI, 40 with inferior MI. Serum NT-proBNP was measured using electrochemiluminiscence assay (Roche). On two-dimensional echocardiography, modified Simpson's technique was used to measure the EF. Follow-up at day 30 included a two-dimensional echocardiography and assessment for worsening heart failure, recurrent ischemia, and repeat hospitalization. Death due to cardiovascular cause by 30 days was also noted. The mean value of NT-proBNP for those having EF over 50% was 1542.38 + 4649.12 pg/ml. For the purpose of a dichotomous analysis, the median value was determined (907.5 pg/ml). In patients having NT-proBNP above median, the Killip class was expectedly higher 1.62 + 0.21 vs 1.0 + 0.12 ( p< 0.05) and the thrombolysis in myocardial infarction scores were worse (4.77 + 1.56 vs 2.71 + 1.11, p < 0.05). The ejection fraction was similar (59.72 + 8.8 vs 58.76 + 6.9, p= NS) in the two groups. At 30 days followup, patients having NT-proBNP above median showed a further decline in the Killip class and EF. The clinical outcomes (composite of recurrent ischemia, worsening heart failure and repeat hospitalization) were also worse in this group ( p< 0.05). CONCLUSION: In patients with apparently normal ejection fraction and without left ventricular dysfunction, a higher NT-proBNP level would suggest poorer short-term clinical outcomes and would require a more aggressive treatment strategy.
Authors:
Aniket Puri; Varun S Narain; Sanjay Mehrotra; Sudhanshu K Dwivedi; Ram K Saran; Vijay K Puri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian heart journal     Volume:  58     ISSN:  0019-4832     ISO Abbreviation:  Indian Heart J     Publication Date:    2006 Mar-Apr
Date Detail:
Created Date:  2008-11-07     Completed Date:  2009-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374675     Medline TA:  Indian Heart J     Country:  India    
Other Details:
Languages:  eng     Pagination:  138-43     Citation Subset:  IM    
Affiliation:
Department of Cardiology, King George Medical University, Lucknow. aniket1@sancharnet.in
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  physiopathology*,  ultrasonography
Natriuretic Peptide, Brain / blood*
Peptide Fragments / blood*
Predictive Value of Tests
Risk Assessment
Stroke Volume*
Ventricular Function, Left*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections
Comment In:
Indian Heart J. 2006 Mar-Apr;58(2):90-2   [PMID:  18989049 ]

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