RESEARCH – May 2006

Natriuretic propeptide – an additional possibility to estimate prognosis in patients with myocardial infarction


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Background. Natriuretic peptides are synthesized in myocardial cells in response to increased wall stress and plasma volume. According to literature data, NT-proBNP (N-terminal propeptide of B-type natriuretic peptide) is a prognostic marker for mortality and development of heart failure (HF) in patients with myocardial infarction (MI). We studied the dynamics of NT-proBNP values in relation to development of HF and long-term mortality in MI patients.
Methods. NT-proBNP was measured in 38 patients with acute MI on admission (NT-proBNP I), the following morning (NT-proBNP II) and on discharge (NT-proBNP III). After a follow up of 13–22 months a questionnaire was sent including questions about the swelling of the lower limbs, dyspnoea, stenocardia and medication. The condition was defined as HF when a patient had 2 features out of 3 (swelling of the lower limbs, dyspnoea, loop-diuretic in treatment scheme).
Results. During hospitalization the NT-proBNP values were 12–13 times higher compared to those for the reference group of same age. During follow-up HF had developed in 8 patients. The NT-proBNP values were higher in the patients with HF compared to the patients without HF; the difference was statistically significant in the case of NT-proBNP I (p = 0.02). By multiple regression analysis, NT-proBNP was a stronger predictor for HF than age, previous MI, diabetes, arterial hypertension or left ventricular ejection fraction (LVEF). During the follow-up period 5 patients died. The levels of NT-proBNP I and NT-proBNP II in those who died during  follow-up were significantly higher compared to the corresponding levels in the survivors (p 0.04 and 0.02, respectively).The strongest prognostic markers for mortality were previous MI, LVEF, cardiac troponinT values and age. NT-proBNP seemed to be less important.
Conclusion. Our results confirm previously published data that NT-proBNP levels are related to the development of HF and mortality following MI. Determination of NTproBNP increases the possibilities to estimate prognosis in patients with MI.