N-terminal probrain natriuretic peptide predicts adverse outcomes in acute-myocardial infarction even with preserved left ventricular ejection fraction

Aniket Puri, Varun S Narain, Sanjay Mehrotra, Sudhanshu K Dwivedi, Ram K Saran, Vijay K Puri
Indian Heart Journal 2006, 58 (2): 138-43

BACKGROUND: Risk stratification of patients with acute myocardial infarction is based on various clinical, biochemical or electrocardiographic parameters. There is emerging evidence that N-terminal probrain natriuretic peptides (NT-proBNP) possess characteristics of an ideal biomarker. In this study we looked into the role of NT-proBNP in risk stratification and prediction of short-term events in patients presenting with acute myocardial infarction (MI) and having preserved left ventricular functions as assessed by ejection fraction (EF) on echocardiography.

METHODS AND RESULTS: Of a total of 250 consecutive patients admitted with a diagnosis of acute ST segment elevation myocardial infarction, 84 patients were found to have ejection fraction greater than 50% (44 with anterior MI, 40 with inferior MI. Serum NT-proBNP was measured using electrochemiluminiscence assay (Roche). On two-dimensional echocardiography, modified Simpson's technique was used to measure the EF. Follow-up at day 30 included a two-dimensional echocardiography and assessment for worsening heart failure, recurrent ischemia, and repeat hospitalization. Death due to cardiovascular cause by 30 days was also noted. The mean value of NT-proBNP for those having EF over 50% was 1542.38 + 4649.12 pg/ml. For the purpose of a dichotomous analysis, the median value was determined (907.5 pg/ml). In patients having NT-proBNP above median, the Killip class was expectedly higher 1.62 + 0.21 vs 1.0 + 0.12 ( p< 0.05) and the thrombolysis in myocardial infarction scores were worse (4.77 + 1.56 vs 2.71 + 1.11, p < 0.05). The ejection fraction was similar (59.72 + 8.8 vs 58.76 + 6.9, p= NS) in the two groups. At 30 days followup, patients having NT-proBNP above median showed a further decline in the Killip class and EF. The clinical outcomes (composite of recurrent ischemia, worsening heart failure and repeat hospitalization) were also worse in this group ( p< 0.05).

CONCLUSION: In patients with apparently normal ejection fraction and without left ventricular dysfunction, a higher NT-proBNP level would suggest poorer short-term clinical outcomes and would require a more aggressive treatment strategy.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"