PLASMA N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AND ADRENOMEDULLIN - NEW NEUROHORMONAL PREDICTORS OF LEFT-VENTRICULAR FUNCTION AND PROGNOSIS AFTER MYOCARDIAL-INFARCTION

Background-Newly discovered circulating peptides, N-terminal pro-brain natriuretic peptide (N-BNP) and adrenomedullin (ADM), were examined f or prediction of cardiac function and prognosis and compared with prev iously reported markers in 121 patients with myocardial infarction. Me thods and Results-The association between radionuclide left ventricula r 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, cG MP, or plasma catecholamine concentrations. For prediction of death ov er 24 months of follow-up, an early postinfarction N-BNP level greater than or equal to 160 pmol/L had sensitivity, specificity, positive pr edictive value, and negative predictive values of 91%, 72%, 39%, and 9 7%, 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 l evel below the group median (Kaplan-Meier survival analysis, P<.00001) . For prediction of heart failure (left ventricular failure), plasma N -BNP greater than or equal to 145 pmol/L had sensitivity (85%) and neg ative predictive value (91%) comparable to the other cardiac peptides and was superior to ADM, plasma catecholamines, and LVEF. By multivari ate analysis, N-BNP but not ADM provided predictive information for de ath and left ventricular failure independent of patient age, sex, LVEF , levels of other hormones, and previous history of heart failure, myo cardial infarction, hypertension, or diabetes. Conclusions-Plasma N-BN P measured 2 to 4 days after myocardial infarction independently predi cted 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 infarctio n.