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(Circulation. 1996;93:1963-1969.)
© 1996 American Heart Association, Inc.
Articles |
Plasma Brain Natriuretic Peptide as an Indicator of Left Ventricular Systolic Function and Long-term Survival After Acute Myocardial Infarction
Comparison With Plasma Atrial Natriuretic Peptide and N-Terminal Proatrial Natriuretic Peptide
From the Department of Clinical Biology, Division of Endocrinology, University of Bergen (Norway) Medical School (T.O., A.A.); Cardiology Division, Department of Medicine, Central Hospital in Rogaland, Stavanger, Norway (V.V.S.B., D.W.T.N., K.D.); Department of Clinical Physiology, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.C.); Section for Medical Statistics and Informatics, University of Bergen, Norway (R.T.L.); and Institute of Medical Biology, University of Tromsø, Norway (J.A.S.).
Correspondence to Torbjørn Omland, MD, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
Background Elevated plasma levels of atrial natriuretic peptide (ANP) and the N-terminal fragment of the ANP prohormone (N-ANP) are associated with decreased left ventricular function and decreased long-term survival after acute myocardial infarction (AMI). Previous data suggest that plasma brain natriuretic peptide (BNP) may increase proportionally more than plasma ANP after AMI and in chronic heart failure. The diagnostic and prognostic value of plasma BNP as an indicator of left ventricular dysfunction and long-term survival after AMI, relative to that of ANP and N-ANP, remain to be established.
Methods and Results Venous blood samples for
analysis of ANP, N-ANP, and BNP were obtained on day 3 after
symptom onset from 131 patients with documented AMI. Left
ventricular ejection fraction was determined by
echocardiography in a subsample of 79 patients.
Twenty-eight cardiovascular and 3
noncardiovascular deaths occurred during the
follow-up period (median, 1293 days). All three peptides proved to
be powerful predictors of cardiovascular mortality by
univariate Cox proportional hazards regression
analyses (ANP: P<.0001; N-ANP: P=.0002;
BNP: P<.0001). In a multivariate model,
plasma BNP (P=.021) but not ANP (P=.638) or N-ANP
(P=.782) provided additional prognostic information beyond
left ventricular ejection fraction. Logistic regression
analysis showed that ANP (P=.003) and N-ANP
(P=.027) but not BNP (P=.14) were significantly
associated with a left ventricular ejection fraction
45%.
Conclusions These results suggest that plasma BNP determination provides important, independent prognostic information after AMI. Although plasma ANP appears to be a better predictor of left ventricular dysfunction, plasma BNP may have greater potential to complement standard prognostic indicators used in risk stratification after AMI because of its strong, independent association with long-term survival, enhanced in vitro stability, and simplicity of analysis.
Key Words: prognosis • atrial natriuretic factor • peptides • myocardial infarction • heart failure
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