Profile of plasma N-terminal proBNP following acute myocardial infarction - Correlation with left ventricular systolic dysfunction

Aims The aims of this study were to describe the temporal pattern of plasma N-terminal pro-brain natriuretic peptide, to examine the optimum time of sampling and to compare plasma N-terminal pro-brain natriuretic peptide to clinical criteria in terms of identification of impaired left ventricular systolic function following acute myocardial infarction. Methods and Results Measurements of N-terminal pro-brain natriuretic peptide were made in 60 patients at 14-48 h. 49-72 h, 73-120 h, 121-192 h following myocardial infarction and at 6 weeks in survivors. Left ventricular wall motion index was assessed during hospitalization (WMI-1) and at 6 weeks (WMI-2). N-terminal pro-brain natriuretic peptide levels were elevated at all time points, to a greater extent in anterior compared to inferior infarction (P<0.05). A biphasic profile of plasma concentration was observed in anterior infarction with peaks at 14-48 h and 121-192 h. This was sustained at 6 weeks. N-terminal pro-brain natriuretic peptide at 73-120 h was the best independent predictor of WMI-1 (P<0.005). N-terminal pro-brain natriuretic peptide was higher at all times in patients who received ACE inhibitor therapy compared to those who did not (P<0.005). N-terminal pro-brain natriuretic peptide at 73-120 h (R-2=17.7%, P=0.005) and previous myocardial infarction (R-2=5.3%, P<0.05) were independent predictors of poor outcome (WMI-2 less than or equal to 1.2 or death by 6 weeks). Conclusions A biphasic pattern of plasma N-terminal pro-brain natriuretic peptide is seen after anterior myocardial infarction. Plasma level is strongly correlated to wall motion index soon after and remote from acute myocardial infarction. Plasma N-terminal pro-brain natriuretic peptide measured later in hospitalization better predicts poor outcome following myocardial infarction than when it is measured in the immediate post infarction period. (Eur Heart J 2000; 21: 1514-1521) (C) 2000 The European Society of Cardiology.