Izvorni znanstveni članak
Biphasic and Monophasic Pattern of Brain Natriuretic Peptide Release in Acute Myocardial Infarction
Mirza Dilić
Azra Durak Nalbantić
Amila Arslanagić
Jasminko Huskić
Snežana Brdjanović
Mehmed Kulić
Enisa Hodžić
Šekib Sokolović
Faris Zvizdić
Alen Džubur
Sažetak
This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as
well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern – concentration in
the first measurement is higher than in the second one, and biphasic pattern – concentration in the first measurement is
lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic
and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23
females, average age of 62.3±10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was
evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p<0.001).
We found statistically significant real negative correlation (p<0.05) between BNP concentration and left ventricle ejection
fraction (LVEF) with high correlation coefficient (r=–0.684). BNP concentrations were significantly higher among patients
in Killip class II and III compared to Killip class I; Killip class I BNP=226.18 pg/mL vs. Killip class II 622.51 pg/mL vs.
Killip class III 1530.28 pg/mL, p<0.001. BNP concentrations were significantly higher in patients with; (i) myocardial infarction
vs. controls; (BNP 835.80 pg/mL vs. 243.03 pg/mL); (ii) in pts with positive major adverse cardiac events (MACE)
vs. negative MACE (BNP 779.08 pg/mL vs. 242.28 pg/mL, p<0.001); (iii) in pts with positive compared to negative left ventricle
(LV) remodelling (BNP 840.77 pg/mL vs. 341.41 pg/mL, p<0.001). Group with biphasic pattern of BNP release had
significantly higher BNP concentration compared to monophasic pattern group. In biphasic pattern group we found significant
presence of lower LVEF, Killip class II and III, LV remodelling and MACE. We found that BNP is strong marker of
adverse cardiac events in patients presenting with a myocardial infarction. In our AMI group we found significant elevation
of BNP and it is suspected that second peak secretion is not only due to systolic dysfunction and subsequent remodeling
of LV but also due to impact of ischaemia. Patients with biphasic pattern probably have worse prognosis due to severe coronary
heart disease. Besides its diagnostic role as a simple blood marker of systolic function, BNP is also important prognostic
marker who helps making clinical decision about early invasive vs. conservative management.
Ključne riječi
brain natriuretic peptide; acute myocardial infarction; biphasic and monophasic pattern of release; diagnostic and prognostic role
Hrčak ID:
64769
URI
Datum izdavanja:
7.3.2011.
Posjeta: 927 *