From the Departments of Cardiology, Endocrinology, and Nuclear Medicine,
Christchurch Hospital and Department of Medicine, Christchurch School of
Medicine, Christchurch, New Zealand.
Correspondence to Prof A.M. Richards, Department of Medicine, Christchurch School of Medicine, Riccarton Ave, PO Box 4345, Christchurch, New Zealand. E-mail bgriffin{at}chmeds.ac.nz
Background—Newly discovered
circulating peptides, N-terminal pro–brain natriuretic
peptide (N-BNP) and adrenomedullin (ADM), were examined for prediction
of cardiac function and prognosis and compared with previously reported
markers in 121 patients with myocardial infarction.
Methods and Results—The association between radionuclide left
ventricular ejection fraction (LVEF) and N-BNP at 2 to 4
days (r=-.63, P<.0001) and 3 to 5
months (r=-.58, P<.0001) after
infarction was comparable to that for C-terminal BNP and far stronger
than for ADM (r=-.26, P<.01),
N-terminal atrial natriuretic peptide (N-ANP), C-terminal
ANP, cGMP, or plasma catecholamine concentrations. For
prediction of death over 24 months of follow-up, an early
postinfarction N-BNP level
Conclusions—Plasma N-BNP measured 2 to 4 days after myocardial
infarction independently predicted left ventricular
function and 2-year survival. Stratification of patients into low- and
high-risk groups can be facilitated by plasma N-BNP or BNP
measurements, and one of these could reasonably be included in the
routine clinical workup of patients after myocardial infarction.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Plasma N-Terminal Pro–Brain Natriuretic Peptide and Adrenomedullin
New Neurohormonal Predictors of Left Ventricular Function and Prognosis After Myocardial Infarction
160 pmol/L had sensitivity, specificity,
positive predictive value, and negative predictive values of 91%,
72%, 39%, and 97%, respectively, and was superior to any other
neurohormone measured and to LVEF. Only 1 of 21 deaths occurred in a
patient with an N-BNP level below the group median (Kaplan-Meier
survival analysis, P<.00001). For prediction of
heart failure (left ventricular failure), plasma N-BNP
145 pmol/L had sensitivity (85%) and negative predictive value
(91%) comparable to the other cardiac peptides and was superior to
ADM, plasma catecholamines, and LVEF. By
multivariate analysis, N-BNP but not ADM
provided predictive information for death and left
ventricular failure independent of patient age, sex, LVEF,
levels of other hormones, and previous history of heart failure,
myocardial infarction, hypertension, or diabetes.
Key Words: brain natriuretic peptide • atrial natriuretic factor • peptides • myocardial infarction • ventricles • prognosis
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