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Diagnostic value of B-type natriuretic peptide concentrations in patients with acute myocardial infarction
D Darbar1, N C Davidson, N Gillespie
1Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6602, USA.
Insights
Plasma B-type natriuretic peptide (BNP) levels after acute myocardial infarction (AMI) strongly predict cardiovascular death. Atrial natriuretic peptide (ANP) levels better indicate risk for heart failure and hospitalization, aiding risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Medicine
Background:
- Elevated atrial natriuretic peptide (ANP) predicts outcomes post-acute myocardial infarction (AMI).
- The prognostic value of B-type natriuretic peptide (BNP) after AMI is not well-established.
Purpose of the Study:
- To evaluate the prognostic significance of plasma ANP and BNP levels in patients following AMI.
- To determine the predictive value of these natriuretic peptides for cardiovascular mortality, heart failure, and hospitalization.
Main Methods:
- Plasma ANP and BNP concentrations were measured in 75 patients approximately 3 days after AMI.
- Patients were followed for a median of 19.7 months for cardiovascular mortality, symptomatic heart failure, and hospitalization.
Main Results:
- Plasma BNP independently predicted cardiovascular mortality (p=0.001).
- Plasma ANP predicted symptomatic heart failure and hospitalization (p=0.002 and p=0.019, respectively).
- Both peptides were valuable for combined endpoints, with BNP for mortality and ANP for heart failure/hospitalization.
Conclusions:
- Plasma BNP is a potent predictor of cardiovascular mortality after AMI.
- Plasma ANP is a better indicator of subsequent symptomatic heart failure and hospitalization risk.
- Measuring both BNP and ANP post-AMI can enhance cardiovascular risk stratification.
Abstract:
Although elevations of plasma atrial natriuretic peptide (ANP) concentrations have been shown to have prognostic significance in patients after acute myocardial infarction (AMI), the relation between plasma levels of B-type natriuretic peptide (BNP) and cardiovascular mortality remains unknown. To test the prognostic value of plasma ANP and BNP after AMI, plasma concentrations were measured a mean of 3 days after infarction in 75 patients. During a median follow-up of 19.7 months, 14 patients (18.4%) died of cardiovascular causes. On univariate analysis, plasma ANP and BNP, Killip class, modified Peel index, left ventricular ejection fraction, and presence of left ventricular failure were all associated with cardiovascular mortality. In contrast, plasma ANP was the only variable that correlated with the development of symptomatic heart failure and hospitalization. For the combined end point of cardiovascular mortality, symptomatic heart failure, and hospitalization, plasma neurohormones were the only variables of predictive value. By stepwise regression analysis, plasma BNP was the only significant independent predictor of cardiovascular mortality (p = 0.001), whereas plasma ANP identified patients at risk of symptomatic heart failure and hospitalization (p = 0.002 and 0.019, respectively). This study indicates that plasma BNP measured after AMI is a powerful neurohormonal predictor of subsequent cardiovascular mortality, whereas plasma ANP correlates better with the development of symptomatic heart failure and hospitalization. Routine measurement of both of these peptides in the period immediately after an AMI may provide a simple means of risk stratification with different information gained from each peptide.