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Prognostic value of plasma atrial natriuretic factor, norepinephrine and epinephrine in acute myocardial infarction
T Omland1, T Aarsland, A Aakvaag
1Medical Department, Central Hospital in Rogaland, Stavange, Norway.
Insights
Early measurement of atrial natriuretic factor (ANF) in acute myocardial infarction (AMI) patients predicts survival. Elevated ANF levels on day 3 after AMI indicate a higher risk of 1-year mortality, independent of heart failure signs.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Neurohumoral activation in acute myocardial infarction (AMI) is linked to hemodynamic compromise, heart failure progression, and arrhythmias.
- Assessing neurohumoral variables may offer prognostic insights in AMI patients.
Purpose of the Study:
- To investigate the prognostic value of plasma neurohormone levels (atrial natriuretic factor, norepinephrine, epinephrine) in patients with AMI.
- To determine if these neurohormonal markers independently predict 1-year mortality.
Main Methods:
- Plasma levels of atrial natriuretic factor (ANF), norepinephrine, and epinephrine were measured in 145 AMI patients on day 3 post-infarction.
- A 360-day follow-up was conducted to record mortality.
- Multivariate analysis was used to assess the independent relationship between hormone levels and mortality, adjusting for clinical and biochemical variables.
Main Results:
- All three measured neurohormones (ANF, norepinephrine, epinephrine) were significantly associated with 1-year mortality in univariate analysis.
- After multivariate adjustment, including clinical heart failure, ANF remained an independent predictor of mortality.
- Elevated ANF levels were associated with significantly increased mortality, whereas elevated norepinephrine levels were not.
Conclusions:
- Early plasma ANF levels are a significant independent predictor of survival in patients with AMI.
- ANF measurement may provide valuable prognostic information beyond clinical assessment of heart failure in AMI.
- Norepinephrine and epinephrine levels, while associated with mortality initially, did not maintain independent prognostic significance after accounting for heart failure.
Abstract:
Neurohumoral activation in acute myocardial infarction (AMI) may reflect the degree of hemodynamic compromise, contribute to the progression of heart failure and augment to the risk of serious ventricular arrhythmias. Consequently, assessment of neurohumoral variables may provide an index of prognostic value in AMI. Plasma levels of atrial natriuretic factor (ANF), norepinephrine and epinephrine were determined in 145 patients on day 3 after AMI. During the 360-day follow-up period 17 patients died. In univariate analysis, all 3 neurohormones were significantly related to 1-year mortality rates (ANF, p < 0.001; norepinephrine, p = 0.009; epinephrine, p = 0.048). After correction for age, sex, anamnestic, biochemical and clinical variables including signs of clinical heart failure in a multivariate model, ANF remained independently related to mortality. The association between plasma norepinephrine and survival failed to reach statistical significance after introduction of clinical heart failure in the model. Comparison of patients subdivided according to median hormone levels (ANF, 30.3 pmol/liter; norepinephrine, 2.29 nmol/liter) demonstrated a significantly increased mortality rate in patients with elevated ANF (p < 0.001), but not elevated norepinephrine levels. These results suggest that early plasma ANF levels are related to survival in patients with AMI, independently of signs of clinical heart failure.