Abstract | AIMS: 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).
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Authors | J E Otterstad, M G St John Sutton, G S Froeland, I Holme, T Skjaerpe, C Hall |
Journal | European heart journal
(Eur Heart J)
Vol. 23
Issue 13
Pg. 1011-20
(Jul 2002)
ISSN: 0195-668X [Print] England |
PMID | 12093053
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright 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
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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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