Circulation, Vol 88, 82-91, Copyright © 1993 by American Heart Association
E Morita, H Yasue, M Yoshimura, H Ogawa, M Jougasaki, T Matsumura, M Mukoyama and K Nakao
BACKGROUND. Brain natriuretic peptide is a novel natriuretic peptide that
is secreted predominantly from the ventricles, and its plasma levels have
been shown to be markedly increased in patients with chronic congestive
heart failure. This study was designed to examine the plasma levels of
brain natriuretic peptide as well as atrial natriuretic peptide in patients
with acute myocardial infarction. METHODS AND RESULTS. We examined the
plasma levels of brain natriuretic peptide as well as atrial natriuretic
peptide in 50 consecutive patients (36 men and 14 women; mean age, 66
years) with acute myocardial infarction over the time course of 4 weeks.
The plasma level of brain natriuretic peptide was significantly increased
on admission in patients with acute myocardial infarction compared with
controls (92 +/- 28 versus 5.2 +/- 0.5 pg/mL, P < .01) and reached the
peak level of 319 +/- 58 pg/mL at 16.4 +/- 0.7 hours after admission.
Thereafter, the level decreased and then again increased, forming the
second peak of 277 +/- 66 pg/mL on day 5. The level then decreased
gradually but was still much higher in the fourth week than that of
controls (149 +/- 47 versus 5.2 +/- 0.5 pg/mL, P < .001). On the other
hand, the plasma atrial natriuretic peptide level already had been
increased at the time of admission compared with controls (116 +/- 14
versus 39.5 +/- 2.6 pg/mL, P < .01) and decreased thereafter, again
increasing and making a small peak on day 2 to 3. The time course of the
plasma brain natriuretic peptide level could be divided into two patterns:
a monophasic pattern with one peak at about 16 hours after admission and a
biphasic pattern with two peaks at about 16 hours and 5 days after
admission. There were significantly more patients with anterior infarction,
congestive heart failure, higher level of maximal creatine kinase-MB
isoenzyme, and lower left ventricular ejection fraction in the biphasic
group than in the monophasic group. CONCLUSIONS. We conclude that the
plasma level of brain natriuretic peptide is increased markedly in patients
with acute myocardial infarction and may reflect the degree of left
ventricular dysfunction in these patients.
ARTICLES
Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction
Division of Cardiology, Kumamoto University School of Medicine, Japan.
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