Coronary artery disease
Usefulness of Serial Assessment of B-Type Natriuretic Peptide, Troponin I, and C-Reactive Protein to Predict Left Ventricular Remodeling After Acute Myocardial Infarction (from the REVE-2 Study)

https://doi.org/10.1016/j.amjcard.2010.06.071Get rights and content

Left ventricular (LV) remodeling after myocardial infarction (MI) indicates a high risk of heart failure and death. However, LV remodeling is difficult to predict, and limited information is available on the association of cardiac biomarkers with LV remodeling. Our aim was to study the association of B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), and C-reactive protein with LV remodeling after MI. We designed a prospective multicenter study including 246 patients with a first anterior Q-wave MI. Serial echocardiographic studies were performed at hospital discharge and 3 months and 1 year after MI; quantitative analysis was performed at a core echocardiographic laboratory. Blood samples for determination of BNP, cTnI, and C-reactive protein levels were obtained at hospital discharge and the 1-month, 3-month, and 1-year follow up visits. One-year echocardiographic follow-up was obtained in 226 patients. End-diastolic volume increased from 52.3 ± 13.8 ml/m2 at baseline to 62.3 ± 18.4 ml/m2 at 1 year (p <0.0001); LV remodeling (>20% increase in end-diastolic volume) was observed in 87 patients (38%). At baseline, we found significant univariate relations between LV remodeling and the 3 biomarkers. During follow-up, high BNP levels and persistently detectable levels of cTnI were associated with LV remodeling. In multivariate analysis, none of the 3 biomarkers at baseline was independently predictive of LV remodeling. In contrast, during follow-up, high BNP and positive cTnI were independently associated with LV remodeling. In conclusion, circulating cardiac biomarkers may reflect pathophysiologic processes implicated in LV remodeling after MI. Determination of BNP and cTnI during follow-up can help refine risk stratification.

Section snippets

Methods

REVE-2 was a multicenter study that enrolled 246 patients with anterior wall Q-wave MI from 8 centers in France (Appendix) from February 2006 to September 2008. Inclusion criteria were hospitalization within 24 hours after symptom onset and ≥3 LV segments of the infarct zone that were akinetic at predischarge echocardiography. Exclusion criteria were inadequate echographic image quality, life-limiting noncardiac disease, significant valvular disease, or previous Q-wave MI. The research protocol

Results

Characteristics of the 246 patients who formed the study population are listed in Table 1.

Baseline echocardiographic study was performed at a mean of 4.0 ± 1.5 days after the MI. During the 1-year follow-up period, 3 patients died (all from cardiovascular causes) and 1 patient underwent heart transplantation. In addition, 3 patients had recurrent MIs during the follow-up period. Echocardiographic follow-up was achieved in 226 of the 242 eligible patients (93%, 1 patient was lost to follow-up

Discussion

The present study provides new information on biological markers associated with LV dilation after MI. We selected 3 biomarkers that assess different pathways implicated in LV remodeling. BNP is synthesized in the ventricular myocardium and released into the circulation in response to ventricular dilation and pressure overload.3 These characteristics make BNP a first-line LV remodeling biomarker candidate. Several investigations, therefore, were performed on the association between BNP and LV

Acknowledgment

The investigators thank Stéphane Dequand and Michel Deneve for monitoring the study and for their help in the Lille Core Echocardiographic Laboratory.

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This study was supported by the CHRU de Lille PHRC 2005R/1901, Lille, the Fondation de France, Paris, and the Région Nord-Pas de Calais.

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