Usefulness of β-type natriuretic peptide in predicting ventricular arrhythmia in patients with left ventricular dysfunction after an acute myocardial infarction.

Document Type : Original papers

Authors

1 lecturer of critical care medicne- Critical care departemnet -Faculty of medicne -Beni Suef University

2 critical care departement,faculty of medicine ,Beni Suef University

Abstract

Objectives
The aim of this study was to evaluate the role of β-type natriuretic peptide (BNP), in prediction of ventricular arrythmia within 90 days after the onset of an acute myocardial infarction (MI) in patients who developed left ventricular systolic dysfunction during such period.
Background
Despite all the advances in therapeutic pharmacological measures and in spite of proven effectiveness of implantable cardioverter defibrillators in prevention and management of ventricular tachycardia, it is still a great problem and a major cause of mortality in this group of patients, so better identification of patients who could benefit from an cardioverter defibrillator and those who are unlikely to benefit would definitely improve the outcome in these patients. Moreover, proper selection would help high-risk patients get benefit from these interventions.
Patients and methods
We measured BNP in 60 consecutive patients after ST-elevation myocardial infarction and who developed left ventricular systolic dysfunction (ejection fraction<50%) (45 males, represent 75%, with mean age of 57.6±8.5 years old),3–5 days only after onset of MI.
Results
Mean age in our patients was 57.6±8.5 years (range: 35–80 years). Men constituted 73.4% (44 men) of our studied patients. We found mean NYHA of 2.9, mean Killip class of 2.8, and mean TIMI risk score of 8.2. Follow-up was done within 90 days. The number of patients who survived was 48 (80%), and ventricular arrhythmias was documented in seven (11.8%) cases. BNP proved to be a useful marker in predicting ventricular tachycardia by plotting the receiver operating characteristic curve that revealed area under the curve of 69.6%.
Conclusion
BNP levels are a strong, independent predictor of sudden death in patients with ischemic cardiomyopathy after an acute MI.

Keywords

References

  1. Manios EG, Kallergis EM, Kanoupakis EM, Mavrakis HE, Kambouraki DC, Arfanakis DA, Vardas PE. Amino-terminal pro-brain natriuretic peptide predicts ventricular arrhythmogenesis in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators. Chest 2005; 128:2604–2610.
  2. Garrone P, Biondi-Zoccai G, Salvetti I. Quantitative coronary angiography in the current era: principles and applications. J Interv Cardiol 2009; 22:527–536.
  3. Josephson M, Wellens HJ. Implantable defibrillators andsudden cardiac death. Circulation 2004; 109:2685–2691.
  4. Huikuri HV, Makikallio TH, Raatikainen MJ, Perkiömäki J, Castellanos A,Myerburg RJ, et al. Prediction of sudden cardiac death: appraisal of the studies and methods assessing the risk of sudden arrhythmic death. Circulation 2003; 108:110–115.
  5. Maisel AS. B-type natriuretic peptide (BNP) levels: diagnose-tic and therapeutic potential. Rev Cardiovasc Med 2001; 2 (Suppl 2):S13–S18.
  6. Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B, Pacher R,et al. B-type natriureticpeptide predicts sudden death in patients with chronic heartfailure. Circulation 2002; 105:2392–2397.
  7. Gardnera RS, Oz ?alpF, Murdaya AJ, Robb SD, McDonagh TA. N-terminal pro-brain natriuretic peptide: a new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 2003; 24:1735–1743.
  8. Koglin J, Pehlivanli S, Schwaiblamir M, Vogeser M, Cremer P, vonScheidt W. Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure. J Am Coll Cardiol 2001; 38:1934–1941.
  9. Harrison A, Morrison LK, Krishnaswamy P, Kazanegra R, Clopton P, Dao Q, et al. B-typenatriuretic peptide (BNP) predicts future cardiac events inpatients presenting to the emergency department with dysnea. Ann Emerg Med 2002; 39:131–138.
  10. Tapanainen JM, Lindgren KS, Mäkikallio TH, Vuolteenaho O, Leppäluoto J,Huikuri HV. Natri-uretic peptides as predictors of non-sudden and suddencardiac death after acute myocardial infarction in the-block-ing era. J Am Coll Cardiol 2004; 43:757–763.
  11. Heeschen C, Hamm CW, Mitrovic V, Lantelme NH, White HD; Platelet Receptor Inhibition in Ischemic Syndrome Management (PRISM) Investigators. N-terminalpro B-type natriuretic peptide levels for dynamic risk strati-fication of patients with acute coronary syndromes. Circulation 2004; 110:3206–3212.
  12. Bassan R, Potsch A, Maisel A, Tura B, Villacorta H, Nogueira MV, et al. Btype natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation. Eur Heart J 2005; 26:234–240.
  13. Potocki M, Mair J, Weber M, Hamm C, Burkard T, Hiemetzberger R, et al.Relation of N-terminal pro-B-type natriuretic peptide to symptoms, severity,and left ventricular remodeling in patients with organic mitral regurgitation.Am J Cardiol 2009; 104:559–564.
  14. Ray IB, Reddy VY. Implanted defibrillators and primary prevention of sudden cardiac death: where are we today? IntJ Cardiol 2005; 98:15–20.
  15. Hansen DE, Craig CS, Hndeghem LM. Stretch-induced arrhythmias in the isolated canine ventricle: evidence for the importance of mechanoelectrical feedback. Circulation 1990; 81:1094–1105.
  16. Franz MR, Cima R, Wang D. Electrophysiological effects of myocardial stretch and mechanical determinants for stretch- activated arrhythmias.Circulation 1992; 86:968–978.
  17. Effects of mechanoelectrical feedback: influence among patients with congestive heart failure. Cardiovasc Res 1996; 32:44–51.
  18. ZhuWX, Johnson SB, Brandt R, Burnett J, PackerDL. Impact of volume loading and load reduction on ventricular refractoriness and conduction properties in canine congestive heart failure. J Am Coll Cardiol 1997; 30:825–833.
  19. Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, et al. Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991; 87:1402–1412.
  20. YoshimuraM, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M,et al. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 1993; 87:464–469.
  21. Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular enddiastolic pressure in patients with symptomatic left ventricular dysfunction.Am Heart J 1998; 135:825–832.
  22. Maisel AS, Krishnaswamy P, NowakRM, McCord J,Hollander JE, Duc P, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347:161–167.
  23. Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A. Utility of a rapid B- natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 2002; 39:202–209.
  24. Yang YJ, Mao Y, Ni XH, Chen JL, Gao RL, Chen ZJ. The predictive value of B-type natriuretic peptide for the mortality from acute myocardial infarction. Zhonghua Nei Ke Za Zhi 2007; 46:450–453.
  25. Galvani M, Ottani F, Oltrona L, Ardissino D, Gensini GF, Maggioni AP, et al.N-terminal pro-brain natriuretic peptide on admission has prognostic value acrossthe whole spectrum of acute coronary syndromes. Circulation 2004; 110:128–134.
  26. Blangy H, Sadoul N, Dousset B, Radauceanu A, Fay R, Aliot E, Zannad F.Serum BNP, hs-C-reactive protein, procollagen to assess the risk of ventricular tachycardia in ICD recipients after myocardial infarction. Europace 2007; 9:724–729.
The Egyptian Journal of Intensive Care and Emergency Medicine
Volume 1, Issue 1
December 2021
Pages 15-22

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