Clinical significance of brain natriuretic peptide in patients with postmyocardial infarction

Background: Risk stratification after acute myocardial infarction (AMI) inc ludes the evaluation of left ventricular (LV) function. Natriuretic peptide s, and particularly brain natriuretic peptide (BNP), emerged as a potential marker of ventricular function and prognosis after AMI. Hypothesis: Brain natriuretic peptide levels are related to ventricular fun ction, either systolic or isolated diastolic, and can give prognostic infor mation in patients surviving AMI. Methods: In all, 101 patients were enrolled. An echocardiographic (M-mode, two-dimensional, and pulsed Doppler) evaluation was performed and blood sam ples for BNP measurement were obtained, Clinical events were recorded durin g 12 month?, of follow-up. Results: A negative correlation between BNP and LV ejection fraction was ob served (r = -0.38; p < 0.001). The BNP levels were higher among patients wi th LV systolic dysfunction than in patients; with isolated diastolic dysfun ction (339.1 +/- 249.9 vs. 168.0 +/- 110.5 pg/ml, p = 0.001), The latter ha d higher levels of BNP than those with normal LV function (68.3 +/- 72.6 pg /ml, p < 0.001). The BNP accuracy to detect LV systolic dysfunction was goo d (area under the ROC curve [AUC] = 0.83) and increased when isolated diast olic dysfunction was also considered (AUC = 0.87. Brain natriuretic peptide had a very good accuracy in the prediction of death (AUC = 0.95) and the d evelopment of heart failure (AUC = 0.90), Conclusion: These results extend previous evidence relating BNP to systolic function after AMI. Furthermore. a relationship between BNP levels and dia stolic function was found. Brain natriuretic peptide had a very good perfor mance in detecting the occurrence of an adverse event. We conclude that BNP can detect high-risk patients and help select patients for more aggressive approaches.