Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction

Objective-To investigate the relation between brain natriuretic peptide (BNP) concentrations and left ventricular remodelling characteristics after acute myocardial infarction. Design-Consecutive sample prospective cohort study. Setting-District general hospital coronary care unit in the north of England. Patients-133 initial survivors of a first myocardial infarction who received thrombolytic treatment. Interventions-Patients had transthoracic echocardiography and BNP concentrations measured at three to seven days (early) and two months (late). Main outcome measures-Wall motion index less than or equal to 1.2, end systolic left ventricular volume index and mortality at one year. Results-Patients with an early wall motion index of less than or equal to 1.2 had higher early and late BNP concentrations (early BNP mean (SEM) 629 (76.2) pg/ml v 334 (20.8) pg/ml, p = 0.001 and late BNP 584 (79.5) pg/ml v 343 (25.0) pg/ml, p = 0.001). Patients with an increase in end systolic left ventricular volume index of > 10% also had higher early and late BNP concentrations (early BNP p = 0.034 and late BNP p = 0.001). Early BNP was significantly associated with one year mortality (p = 0.003). Conclusions-Higher BNP concentrations early after first myocardial infarction are associated with adverse left ventricular remodelling characteristics. This may help explain why BNP is such a strong predictor of outcome after myocardial infarction.