Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction

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Abstract
OBJECTIVE To investigate the relation between brain natriuretic peptide (BNP) concentrations and left ventricular remodelling characteristics after acute myocardial infarction. DESIGN Consecutive sample prospective cohort study. SETTING District general hospital coronary care unit in the north of England. PATIENTS 133 initial survivors of a first myocardial infarction who received thrombolytic treatment. INTERVENTIONS Patients had transthoracic echocardiography and BNP concentrations measured at three to seven days (early) and two months (late). MAIN OUTCOME MEASURES Wall motion index ⩽ 1.2, end systolic left ventricular volume index and mortality at one year. RESULTS Patients with an early wall motion index of ⩽ 1.2 had higher early and late BNP concentrations (early BNP mean (SEM) 629 (76.2) pg/ml v 334 (20.8) pg/ml, p = 0.001 and late BNP 584 (79.5) pg/mlv 343 (25.0) pg/ml, p = 0.001). Patients with an increase in end systolic left ventricular volume index of > 10% also had higher early and late BNP concentrations (early BNP p = 0.034 and late BNP p = 0.001). Early BNP was significantly associated with one year mortality (p = 0.003). CONCLUSIONS Higher BNP concentrations early after first myocardial infarction are associated with adverse left ventricular remodelling characteristics. This may help explain why BNP is such a strong predictor of outcome after myocardial infarction.

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