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Prognostic value of two-dimensional echocardiography and N-terminal proatrial natriuretic peptide following an acute myocardial infarction. Assessment of baseline values (2-7 days) and changes at 3 months in patients with a preserved systolic function.

AbstractAIMS:
The purpose of this prospective, observational study was to evaluate the relationship of left ventricular volumes, systolic function and plasma N-terminal proatrial natriuretic peptide (Nt-proANP) to cardiac morbidity and mortality in post-myocardial infarction patients with left ventricular ejection fraction > or =40%.
METHODS AND RESULTS:
Two-dimensional echocardiographic recordings and Nt-proANP measurements were obtained in 834 patients who survived acute myocardial infarction. Patients were examined at 2-7 days and 3 months after the index infarction and followed up for 24 months. All measurements of left ventricular volumes, ejection fraction and Nt-proANP were performed in core laboratories. During follow-up 102 patients sustained one or more incidents of the combined primary end-point: cardiac death (n=11), recurrent infarction (n=55) or heart failure requiring hospitalization or treatment with an ACE inhibitor and a diuretic (n=52). Using Cox proportional hazards model, baseline Nt-proANP predicted these events (chi-square 25.3, P<0.0001), while baseline echo volumes and ejection fraction did not. During the subsequent 3-24 month period, 51 patients suffered a primary end-point: cardiac death (n=9), recurrent infarction (n=29), heart failure (n=21). An increase in left ventricular end-systolic volume was the strongest predictor for adverse events (chi-square 19.1, P<0.0001), especially for heart failure. Individual changes in Nt-proANP did not predict cardiac events, whereas both echocardiographic variables and Nt-proANP measured at 3 months had a prognostic impact on subsequent cardiac events (3-24 months).
CONCLUSIONS:
In post-myocardial infarction patients with preserved left ventricular function (left ventricular ejection fraction > or =40%) baseline Nt-proANP, but not echocardiographic left ventricular volumes predicted adverse cardiac events. Early changes in left ventricular volumes and ejection fraction from baseline to 3 months had a further prognostic impact on subsequent events (3-24 months).
AuthorsJ E Otterstad, M G St John Sutton, G S Froeland, I Holme, T Skjaerpe, C Hall
JournalEuropean heart journal (Eur Heart J) Vol. 23 Issue 13 Pg. 1011-20 (Jul 2002) ISSN: 0195-668X [Print] England
PMID12093053 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
CopyrightCopyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Chemical References
  • Biomarkers
  • N-terminal proatrial natriuretic peptide
  • Protein Precursors
  • Atrial Natriuretic Factor
Topics
  • Aged
  • Atrial Natriuretic Factor (blood)
  • Biomarkers (blood)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction (blood, diagnostic imaging, mortality)
  • Norway
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Protein Precursors (blood)
  • Stroke Volume
  • Ultrasonography
  • Ventricular Dysfunction, Left (blood, diagnostic imaging)
  • Ventricular Remodeling

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