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Human recombinant-B-type natriuretic peptide protect ventricular function and structure in ST-elevation myocardial
Xin Gong1, Zhengbin Mou2, Li Shao1
1Department of Integrated Traditional and Western Medicine, Yuhuangding Hospital Yantai, Shandong, China.
Insights
Recombinant human brain natriuretic peptide (rh-BNP) therapy improved cardiac function in ST-elevation myocardial infarction (STEMI) patients with heart failure. rh-BNP therapy enhanced the 6-minute walking test but was not an independent predictor of major adverse cardiac events.
Area of Science:
- Cardiology
- Pharmacology
Background:
- ST-elevation myocardial infarction (STEMI) is a severe form of coronary artery disease (CAD) leading to adverse left ventricular (LV) remodeling and impaired cardiac function.
- Post-MI remodeling negatively impacts LV function, increasing risks of heart failure and cardiac death.
Purpose of the Study:
- To evaluate the efficacy of 72-hour intravenous infusion of recombinant human brain natriuretic peptide (rh-BNP) in STEMI patients.
- To assess rh-BNP's role in preventing adverse LV remodeling and preserving LV function, with or without successful primary percutaneous coronary intervention (PCI).
Main Methods:
- A study involving 100 STEMI patients with acute heart failure (Killip class ≥ 2) was conducted.
- Patients were divided into an rh-BNP treatment group (n=50) and a control group (n=50).
- The rh-BNP group received a 72-hour infusion alongside conventional therapy; all patients were followed up for 3 months, assessing cardiac function via echocardiography and the 6-minute walking test (6WMT).
Main Results:
- rh-BNP infusion significantly reduced NT-proBNP levels, decreased LV end-systolic diameter (LVESD), and increased LV ejection fraction (LVEF).
- A significant improvement in the 6-minute walking test (6WMT) was observed in the rh-BNP group compared to the control group (P<0.001).
- Multivariate analysis identified rh-BNP usage as an independent predictor for improved 6WMT, but not for major adverse cardiac events (MACE).
Conclusions:
- rh-BNP therapy demonstrated a protective effect on ventricular function and structure in STEMI patients.
- While not an independent predictor of MACE in this study, rh-BNP is a valuable prognostic factor for 6WMT in STEMI patients.
- The findings support rh-BNP's utility in managing STEMI patients with heart failure, particularly in improving functional capacity.
Background:
ST-elevation myocardial infarction (STEMI) is the most serious clinical type of coronary artery disease (CAD), which will lead to a loss of contractile function asa result of adverse left ventricular (LV) remodeling. Post-myocardial infarction remodeling is detrimental to the left ventricular function, which is strongly related to clinical outcome,including heart failure and cardiac death. And our study was designed to assess the efficacy of 72-hour IV infusion of rh-BNP therapy in STEMI patients with or without successful primary PCI, in preventing adverse LV remodeling and preserving LV function.
Methods:
100 patients diagnosed as STEMI combined with acute heart failure (Killip classification ≥ 2) were recorded. And they were divided into "rh-BNP treatment group" (n=50) and "control group" (n=50). In addition to conventional heart failure therapy, patients in the rh-BNP group received rh-BNP infusion for 72 hours. All patients were followed up at 3 month after discharge. Their medical history was taken, as well as the presence or absence of relevant symptoms. 6-minute walking test, as well as echocardiographic indexes were recorded to evaluate the improvement of cardiac function.
Results:
The data analysis about demographic comparison, including those related complicated diseases among groups showed no significant difference. After the follow-up, the indicators were all better than baseline among four subgroups (all P<0.001). Results showed that rh-BNP was able to significantly reduce the NT-pro BNP levels (P<0.001), decrease LVESD (P<0.01), and increase LVEF (P<0.05). The difference of 6WMT between two groups was significant (P<0.001). According to the classification of 6WMT, the multivariate Cox regression showed that the usage of rh-BNP was an independent predictor for 6WMT (OR 0.478, 95% CI, 0.290-0.787), while it may not for MACE (OR 1.762, 95% CI, 0.793-3.913).
Conclusions:
Although the use of rh-BNP was not an independent risk factor in prediction of MACE in our study, the current data still showed that rh-BNP is a useful prognosis factor of 6WMT in the STEMI patients. The protection of ventricular function and structure in STEMI patients is affirmative.
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