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Catecholaminergic activation in acute myocardial infarction: time course and relation to left ventricular performance
Claus Leth Petersen1, Jens Rokkedal Nielsen, Bodil Laub Petersen
1Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. CLPetersen@dadlnet.dk
Insights
Early high levels of adrenaline and noradrenaline in acute myocardial infarction (AMI) predict poor cardiac performance. Normal noradrenaline levels at admission indicate a good left-ventricular ejection fraction (LVEF) at discharge.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Acute myocardial infarction (AMI) triggers a significant stress response.
- Catecholamines, such as adrenaline (ADR) and noradrenaline (NOR), are key mediators of this response.
- Understanding their temporal dynamics and correlation with cardiac function is crucial for patient outcomes.
Purpose of the Study:
- To investigate the time course of catecholaminergic activation (ADR and NOR) in patients with AMI.
- To determine the relationship between early catecholamine levels and subsequent cardiac performance, specifically left-ventricular ejection fraction (LVEF).
Main Methods:
- Studied 18 patients with their first AMI.
- Collected blood samples at multiple time points: admission, discharge, day 6, and 1 year post-event.
- Assessed LVEF using radionuclide ventriculography at discharge and 1-year follow-up.
Main Results:
- ADR and NOR levels were significantly elevated on admission and decreased by discharge, remaining stable thereafter.
- Initial peak ADR and NOR concentrations strongly correlated with lower LVEF at discharge.
- Patients with normal NOR levels (<3 nmol/l) on admission exhibited normal or near-normal LVEF at discharge.
Conclusions:
- Catecholaminergic activation in AMI is acute, peaking within the first 5 days and stabilizing thereafter.
- The extent of early catecholamine elevation is a significant predictor of left ventricular systolic performance.
- Normal admission NOR levels are a reliable indicator of preserved LVEF post-AMI.
Aim:
The study was designed to assess (1) the time course of catecholaminergic activation in acute myocardial infarction (AMI) as estimated by adrenaline (ADR) and noradrenaline (NOR) concentrations, and (2) to relate activation of these hormones to predict the outcome of cardiac performance.
Patients And Methods:
Eighteen patients with first AMI were studied. Blood samples were drawn within the first 4-18 h, after 18-24 h, on day 2, day 3 and on day 6 as well as after 1 year. Radionuclide ventriculography was performed on the day of discharge and after 1 year to determine left-ventricular ejection fraction (LVEF).
Results:
In the study group as a whole, the concentrations of ADR decreased from (mean +/- SEM) 0.80 +/- 0.12 nmol/l on admission to 0.33 +/- 0.03 nmol/l at discharge (p < 0.05). NOR decreased from 4.19 +/- 0.78 to 2.44 +/- 0.33 nmol/l (p < 0.05). Initial peak concentrations of both ADR and NOR on admission were correlated to LVEF at discharge (r = -0.56, p < 0.05 and r = -0.72, p < 0.05, respectively). If NOR was normal (<3 nmol/l) at admission, the LVEF was normal or almost normal (= 0.46) at discharge. The mean plasma level of ADR and NOR after 1 year follow-up was 0.34 +/- 0.04 and 1.95 +/- 0.25 nmol/l, respectively. The values after 1 year were unchanged compared to values at discharge, at day 6 (n.s.). Mean LVEF was 0.50 +/- 0.03 (range: 0.23-0.69) at discharge and unchanged 0.46 +/- 0.05 (range: 0.18-0.72) at 1 year follow-up (n.s.). During hospitalisation, the group with LVEF <0.50 had an 86% higher initial ADR and an 82% higher initial NOR concentration compared to values in patients with LVEF >0.50 (p < 0.05).
Conclusion:
(1) Catecholaminergic activation, as measured by plasma ADR and NOR in AMI, is acute and restricted to the first 5 days. Thereafter, the hormone levels are normal and stable. (2) The magnitude of the early catecholaminergic activation correlates with left ventricular systolic performance. (3) Normal NOR values at admittance predicts normal or almost normal LVEF at discharge.