N-terminal proatrial natriuretic peptide predicts two-year remodelling in patients with acute transmural myocardial...

To evaluate whether baseline N-terminal proatrial natriuretic peptide (Nt-proANP) or Doppler echocardiographic parameters could predict two-year left ventricular remodelling after acute myocardial infarction in patients without heart failure.

Seventy-one patients were followed with Doppler echocardiographic examinations at baseline, 3 months, 1 and 2 years, and Nt-proANP was measured at baseline and 3 months. After 2 years there was a significant increase in end-diastolic volume index of 11% ( p=0.006 ) and end-systolic volume index of 14% ( p=0.03 ), and no change in ejection fraction. This remodelling was confined to 12 patients (17%) with a significant increase in end-diastolic volume index above 20 ml/m(2). Baseline Nt-proANP ( p<0.0005 ), 3-month changes in end-diastolic volume index ( p=0.007 ), and 3-month E/A ratio ( p=0.014 ) were independent positive predictors for two-year changes in end-diastolic volume index. Two-year dilatation above 20 ml/m2 was predicted by baseline Nt-proANP (p=0.014) and maximal velocity of systolic pulmonary venous flow ( p=0.034 ).

Seventeen percent of patients with transmural myocardial infarction and no baseline heart failure experienced a significant left ventricular dilatation at 2 years, and this was best predicted by baseline Nt-proANP. Unstructured abstract Seventy-one patients with acute myocardial infarction and no heart failure were followed for two years in an observational Doppler echocardiographic study. There was a significant increase in end-diastolic volume index of 11% ( p=0.006 ) and end-systolic volume index of 14% (p=0.03), but no change in ejection fraction after two years. Nt-proANP was the strongest independent predictor of two-year changes in end-diastolic volume index and of an increase in end-diastolic volume index above 20 ml/m2 after two years.