PLASMA BRAIN NATRIURETIC PEPTIDE AS AN INDICATOR OF LEFT-VENTRICULAR SYSTOLIC FUNCTION AND LONG-TERM SURVIVAL AFTER ACUTE MYOCARDIAL-INFARCTION - COMPARISON WITH PLASMA ATRIAL-NATRIURETIC-PEPTIDE AND N-TERMINAL PROATRIAL NATRIURETIC PEPTIDE

Background Elevated plasma levels of atrial natriuretic peptide (ANP) and the N-terminal fragment of the ANP prohormone (N-ANP) are associat ed with decreased left ventricular function and decreased long-term su rvival after acute myocardial infarction (AMI). Previous data suggest that plasma brain natriuretic peptide (BNP) may increase proportionall y more than plasma ANP after AMI and in chronic heart failure. The dia gnostic and prognostic value of plasma BNP as an indicator of left ven tricular dysfunction and long-term survival after AMI, relative to tha t of ANP and N-ANP, remain to be established. Methods and Results Veno us blood samples for analysis of ANP, N-ANP, and BNP were obtained on day 3 after symptom onset from 131 patients with documented AMI. Left ventricular ejection fraction was determined by echocardiography in a subsample of 79 patients. Twenty-eight cardiovascular and 3 noncardiov ascular deaths occurred during the follow-up period (median, 1293 days ). All three peptides proved to be powerful predictors of cardiovascul ar mortality by univariate Cox proportional hazards regression analyse s (ANP: P<.0001; N-ANP: P=.0002; BNP: P<.0001). In a multivariate mode l, plasma BNP (P=.021) but not ANP (P=.638) or N-ANP (P=.782) provided additional prognostic information beyond left ventricular ejection fr action. Logistic regression analysis showed that ANP (P=.003) and N-AN P (P=.027) but not BNP (P=.14) were significantly associated with a le ft ventricular ejection fraction less than or equal to 45%. Conclusion s These results suggest that plasma BNP determination provides importa nt, independent prognostic information after AMI. Although plasma ANP appears to be a better predictor of left ventricular dysfunction, plas ma BNP may have greater potential to complement standard prognostic in dicators used in risk stratification after AMI because of its strong, independent association with long-term survival, enhanced in vitro sta bility, and simplicity of analysis.