B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction

被引:383
作者
Richards, AM
Nicholls, MG
Espiner, EA
Lainchbury, JG
Troughton, RW
Elliott, J
Frampton, C
Turner, J
Crozier, IG
Yandle, TG
机构
[1] Christchurch Hosp, Dept Nucl Med, Christchurch, New Zealand
[2] Christchurch Hosp, Dept Cardiol, Christchurch, New Zealand
关键词
coronary disease; natriuretic peptides; heart failure;
D O I
10.1161/01.CIR.0000070953.76250.B9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-A recent landmark report has demonstrated that plasma B-type natriuretic peptide (BNP) measured in acute coronary syndromes independently predicts mortality, heart failure, and new myocardial infarction. After acute cardiac injury, left ventricular ejection fraction (LVEF) is also of prognostic significance and plays a major role in determining the therapeutic response. Methods and Results-The present report is the first from a substantial (n = 666) cohort of patients with acute myocardial infarction to test the prognostic utility of concurrent measurements of BNP, amino-terminal BNP (N-BNP), norepinephrine, and radionuclide LVEF. The B-type peptides and LVEF were predictors of death, heart failure, and new myocardial infarction (all P < 0.001) independent of patient age, gender, previous myocardial infarction, antecedent hypertension or diabetes, previous heart failure, plasma norepinephrine, creatinine, cholesterol, drug therapy, and coronary revascularization procedures. The combination of N-BNP (or BNP) with LVEF substantially improved risk stratification beyond that provided by either alone. Elevated N-BNP (or BNP) predicted new myocardial infarction only in patients with LVEF < 40%. LVEF < 40% coupled to N-BNP over the group median conferred substantial 3-year risks of death, heart failure, and new myocardial infarction of 37%, 18%, and 26%, respectively. N-BNP and BNP were equivalent prognostic markers for these clinical outcomes. Conclusions-Plasma N-BNP (or BNP) and LVEF are complementary independent predictors of major adverse events on follow-up after myocardial infarction. Combined measurement provides risk stratification substantially better than that provided by either alone.
引用
收藏
页码:2786 / 2792
页数:7
相关论文
共 33 条
  • [21] EFFECT OF CAPTOPRIL ON MORTALITY AND MORBIDITY IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION AFTER MYOCARDIAL-INFARCTION - RESULTS OF THE SURVIVAL AND VENTRICULAR ENLARGEMENT TRIAL
    PFEFFER, MA
    BRAUNWALD, E
    MOYE, LA
    BASTA, L
    BROWN, EJ
    CUDDY, TE
    DAVIS, BR
    GELTMAN, EM
    GOLDMAN, S
    FLAKER, GC
    KLEIN, M
    LAMAS, GA
    PACKER, M
    ROULEAU, J
    ROULEAU, JL
    RUTHERFORD, J
    WERTHEIMER, JH
    HAWKINS, CM
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1992, 327 (10) : 669 - 677
  • [22] Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin - New neurohormonal predictors of left ventricular function and prognosis after myocardial infarction
    Richards, AM
    Nicholls, MG
    Yandle, TG
    Frampton, C
    Espiner, EA
    Turner, JG
    Buttimore, RC
    Lainchbury, JG
    Elliott, JM
    Ikram, H
    Crozier, IG
    Smyth, DW
    [J]. CIRCULATION, 1998, 97 (19) : 1921 - 1929
  • [23] Neurohumoral prediction of benefit from carvedilol in ischemic left ventricular dysfunction
    Richards, AM
    Doughty, R
    Nicholls, MG
    Macmahon, S
    Ikram, H
    Sharpe, N
    Espiner, EA
    Frampton, C
    Yandle, TG
    [J]. CIRCULATION, 1999, 99 (06) : 786 - 792
  • [24] Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin - Prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction
    Richards, AM
    Doughty, R
    Nicholls, MG
    MacMahon, S
    Sharpe, N
    Murphy, J
    Espiner, EA
    Frampton, C
    Yandle, TG
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 37 (07) : 1781 - 1787
  • [25] Activation of Neurohumoral Systems in Postinfarction Left Ventricular Dysfunction
    Rouleau, Jean L.
    de Champlain, Jacques
    Klein, Marc
    Bichet, Daniel
    Moye, Lemuel
    Packer, Milton
    Dagenais, Gilles R.
    Sussex, Bruce
    Arnold, J. Malcolm
    Sestier, Francois
    Parker, John O.
    McEwan, Patricia
    Bernstein, Victoria
    Cuddy, T. Edward
    Lamas, Gervasio
    Gottlieb, Stephen S.
    McCans, John
    Nadeau, Claude
    Delage, Francois
    Hamm, Peggy
    Pfeffer, Marc A.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (02) : 390 - 398
  • [26] PROGNOSTIC VALUE OF NEUROHUMORAL ACTIVATION IN PATIENTS WITH AN ACUTE MYOCARDIAL-INFARCTION - EFFECT OF CAPTOPRIL
    ROULEAU, JL
    PACKER, M
    MOYE, L
    DECHAMPLAIN, J
    BICHET, D
    KLEIN, M
    ROULEAU, JR
    SUSSEX, B
    ARNOLD, JM
    SESTIER, F
    PARKER, JO
    MCEWAN, P
    BERNSTEIN, V
    CUDDY, TE
    LAMAS, G
    GOTTLIEB, SS
    MCCANS, J
    NADEAU, C
    DELAGE, F
    WUN, CCC
    PFEFFER, MA
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 24 (03) : 583 - 591
  • [27] HORMONES REGULATING CARDIOVASCULAR FUNCTION IN PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE AND THEIR RELATION TO MORTALITY
    SWEDBERG, K
    ENEROTH, P
    KJEKSHUS, J
    WILHELMSEN, L
    [J]. CIRCULATION, 1990, 82 (05) : 1730 - 1736
  • [28] Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations
    Troughton, RW
    Frampton, CM
    Yandle, TG
    Espiner, EA
    Nicholls, MG
    Richards, AM
    [J]. LANCET, 2000, 355 (9210) : 1126 - 1130
  • [29] Tsutamoto T, 1997, CIRCULATION, V96, P509
  • [30] PREVALENCE, CLINICAL-FEATURES AND PROGNOSIS OF DIASTOLIC HEART-FAILURE - AN EPIDEMIOLOGIC PERSPECTIVE
    VASAN, RS
    BENJAMIN, EJ
    LEVY, D
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (07) : 1565 - 1574