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. 2001 Dec;86(6):638–642. doi: 10.1136/heart.86.6.638

Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction

J Crilley 1, M Farrer 1
PMCID: PMC1730033  PMID: 11711456

Abstract

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 ⩽ 1.2, end systolic left ventricular volume index and mortality at one year.
RESULTS—Patients with an early wall motion index of ⩽ 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.


Keywords: brain natriuretic peptide; wall motion index; left ventricular volume index; myocardial infarction

Full Text

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Figure 1  .

Figure 1  

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Box plot showing median, interquartile range (grey box), sample range (error bars) and outliers (open circles) for brain natriuretic peptide (BNP) measured at three to seven days (early) versus cardiac death, alive at one year, and non-cardiac death.

Figure 2  .

Figure 2  

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Bar chart showing mean early BNP (black bars) and late BNP (grey bars) versus early wall motion index (WMI) ⩽ 1.2 and early WMI > 1.2. n, number in each group.

Figure 3  .

Figure 3  

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Receiver operating characteristic curve for early BNP versus early WMI ⩽ 1.2. 

Figure 4  .

Figure 4  

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Bar chart showing mean early BNP (black bars) and late BNP (grey bars) versus > 10% rise in end systolic volume index (ESVi), no change, and > 10% fall in ESVi.

Selected References

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