Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction - Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide

被引:612
作者
Omland, T
Aakvaag, A
Bonarjee, VVS
Caidahl, K
Lie, RT
Nilsen, DWT
Sundsfjord, JA
Dickstein, K
机构
[1] UNIV BERGEN, SCH MED, DEPT BIOL CLIN, DIV ENDOCRINOL, N-5020 BERGEN, NORWAY
[2] CENT HOSP ROGALAND, DIV CARDIOL, DEPT MED, STAVANGER, NORWAY
[3] GOTHENBURG UNIV, DEPT CLIN PHYSIOL, SAHLGRENS UNIV HOSP, S-41124 GOTHENBURG, SWEDEN
[4] UNIV BERGEN, SECT MED STAT & INFORMAT, N-5020 BERGEN, NORWAY
[5] UNIV TROMSO, MED BIOL INST, N-9001 TROMSO, NORWAY
关键词
prognosis; atrial natriuretic factor; peptides; myocardial infarction; heart failure;
D O I
10.1161/01.CIR.93.11.1963
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Elevated plasma levels of atrial natriuretic peptide (ANP) and the N-terminal fragment of the ANP prohormone (N-ANP) are associated with decreased left ventricular function and decreased long-term survival after acute myocardial infarction (AMI). Previous data suggest that plasma brain natriuretic peptide (BNP) may increase proportionally more than plasma ANP after AMI and in chronic heart failure. The diagnostic and prognostic value of plasma BNP as an indicator of left ventricular dysfunction and long-term survival after AMI, relative to that of ANP and N-ANP, remain to be established. Methods and Results Venous blood samples for analysis of ANP, N-ANP, and BNP were obtained on day 3 after symptom onset from 131 patients with documented AMI. Left ventricular ejection fraction was determined by echocardiography in a subsample of 79 patients. Twenty-eight cardiovascular and 3 noncardiovascular deaths occurred during the follow-up period (median, 1293 days). All three peptides proved to be powerful predictors of cardiovascular mortality by univariate Cox proportional hazards regression analyses (ANP: P<.0001; N-ANP: P=.0002; BNP: P<.0001). In a multivariate model, plasma BNP (P=.021) but not ANP (P=.638) or N-ANP (P=.782) provided additional prognostic information beyond left ventricular ejection fraction. Logistic regression analysis showed that ANP (P=.003) and N-ANP (P=.027) but not BNP (P=.14) were significantly associated with a left ventricular ejection fraction less than or equal to 45%. Conclusions These results suggest that plasma BNP determination provides important, independent prognostic information after AMI. Although plasma ANP appears to be a better predictor of left ventricular dysfunction, plasma BNP may have greater potential to complement standard prognostic indicators used in risk stratification after AMI because of its strong, independent association with long-term survival, enhanced in vitro stability, and simplicity of analysis.
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页码:1963 / 1969
页数:7
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