Brain natriuretic peptide and other cardiac markers predicting left ventricular remodeling and function two years after myocardial infarction

Regina Grybauskienė, Dovilė Karčiauskaitė, Julija Braždžionytė¹, Jūratė Janėnaitė, Zita Bertašienė, Pranas Grybauskas

Institute of Cardiology, ¹Department of Cardiology, Kaunas University of Medicine, Lithuania

Key words: brain natriuretic peptide; cardiac markers; left ventricular remodeling; myocardial infarction.

Summary. Background. Left ventricular remodeling is a complex pathologic process of progressive left ventricular dilatation, leading to dysfunction and heart failure in patients after myocardial infarction.

Objective. To evaluate biochemical markers, reflecting cardiac remodeling process after first myocardial infarction and compare those markers with clinical characteristics of left ventricular remodeling.

Material and methods. Brain natriuretic peptide, troponin I, creatine kinase, creatine kinase MB mass, lactate dehydrogenase levels were measured in 30 patients with acute myocardial infarction on days 1, 2, 3–7 . Brain natriuretic peptide was measured at 3 months, 6 months, and 2 years after myocardial infarction. Echocardiographic parameters of left ventricular remodeling were determined in acute phase (day 1–3), at 3 months, 6 months, and 2 years after MI.

Results. In acute phase, brain natriuretic peptide level progressively increased according to worsening of left ventricular geometry: in normal left ventricle geometry group, brain natriuretic peptide level was 84.1 (58.7–121) pg/mL, in concentric remodeling group – 125 (69.2–165) pg/mL, in concentric hypertrophy group – 128 (74–368) pg/mL, and in eccentric hypertrophy group – 470 (459–494) pg/mL, P=0.02. Patients who had increased left ventricular end diastolic diameter index during 2-year period had higher brain natriuretic peptide level in the acute phase (584 (249–865) pg/mL vs. 120 (67–202) pg/mL, P=0.04) and also higher peak lactate dehydrogenase and troponin I levels.

Conclusions. Brain natriuretic peptide level in acute phase of myocardial infarction is strongly associated with the markers of myocardial injury and related to left ventricular geometry changes and remodeling. Brain natriuretic peptide together with troponin I levels in acute phase of myocardial infarction might be useful in predicting subsequent cardiac function.

Correspondence to R. Grybauskienė, Institute of Cardiology, Kaunas University of Medicine, Sukilėlių 17, 50161 Kaunas, Lithuania. E-mail: reggryb@med.kmu.lt

Received 23 January 2007, accepted 3 September 2007