Background and Objective:
The progression of left ventricular(LV) remodeling after acute myocardial infarction(AMI) has been shown to adversely affect prognosis. Level of serum brain-type natriuretic peptide(BNP) at early phase is powerful predictor of major adverse cardiac events. We sought to examine the relation between level of BNP and LV remodeling in patients with AMI.
Method: From April 2003 to June 2006, among 334 AMI patiients, we analyzed 131 patients underwent echocardiography on 1 to 5th day(initial) and 6 to 9 months(follow-up) and measurements of BNP(Triage®) on admission(≤24hr), early(24hr-6day), and long-term phase(6 to 9 months) after AMI. LV remodeling was defined as an increase in end-diastolic volume(EDV) ≥15% between initial and follow-up period. We divided them into remodeling group and nonremodeling group and compared two groups. LV volume was measured by modified Simpson’s method.
Results:
Mean age was 59.7±11.6 and male sex was 71.8%. Primary PCI rate was 71.7%. Angiographic data showed the most common infarct related artery was LAD(46.6%). Mean symptom to reperfusion time was later in remodeling group(6.5±3.1 vs. 4.7±2.2 hours, p=0.000). Mean levels of BNP at early phase(371.6±458.7 vs 93.6 ±187.3 pg/mL, p=0.000) were higher in remodeling group. Initial echocardiography was performed 3.3±2 days and follow-up images obtained 6.4±1.6 months. In remodeling group, mean value of changed LV EDV was 17.1±13.1 mL. Initial echocardiographic were revealed as higher LV end-systolic volume(37.2±11.4 vs. 31.6±14.4 mL, p=0.028), wall-motion score(31.9±11.4 vs. 26.4±5.2, p=0.000). Multivariable regression analyses confirmed that level of BNP at early phase(odds ratio 0.996, p=0.003) and peak creatine kinase-MB(odds ratio 0.991, p=0.002) were the powerful independent predictors of LV remodeling in patients with AMI. On ROC curve, the best value of BNP at early period in prediction for LV remodeling was 91.2 pg/mL (accuracy 78.0 %, p=0.000).
Conclusion :
The level of BNP is well correlate with LV remodeling. Especially, levels of BNP at early phase can be useful predictors of LV remodeling after AMI.
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