Changes in vasoconstrictive hormones, natriuretic peptides, and left ventricular remodeling soon after anterior myocardial infarction

Objective Our purpose was to study the changes in vasoconstrictive neurohor mones, N-terminal proatrial natriuretic peptide (Nt-proANP), and brain natr iuretic peptide (BNP) and their relationship with left ventricular (IV) rem odeling soon after anterior myocardial infarction (MI). Background The Healing and Afterload Reducing Therapy (HEART) trial has sho wn that early use of ramipril improves left ventricular ejection fraction ( LVEF) and attenuates IV remodeling when initiated soon after MI. This neuro humoral substudy of HEART investigates the changes in vasoconstrictive and natriuretic peptides and their relationship with IV remodeling. Methods One hundred twenty-two patients had blood drawn for the measurement of catecholamines, endothelin-1, angiotensin II, Nt-proANP and BNP, and pr ostacyclins within 24 hours of an MI, and at 3, 14, and 90 days after the M I. Quantitative echocardiograms were performed at baseline and at 14 days. Results All neurohormones except angiotensin. II (P = .12) and prostaglandi ns were significant. ly elevated at baseline. Vasoconstrictive neurohormone s decreased significantly over time but remained elevated at 14 days. Both Nt-proANP and BNP were elevated within the First 14 days. BNP decreased sig nificantly by 90 days, whereas Nt-proANP exhibited no change between 14 and 90 days. Ramipril decreased plasma levels of angiotensin II at 3 days but had no effect on the other neurohormones. Conclusions Neurohumoral activation occurs and persists in patients with an terior MI and overall preserved LV function. Ramipril had only a modest imp act on neurohormones despite its significant benefits on LV remodeling soon after MI.