Key result
Early-phase BNP-cGMP cascade activation predicts LV reverse remodeling linked to ~74% lower MACCE risk.
Why the study?
The role of cGMP after AMI was not well understood despite its significance as a second messenger of natriuretic peptides in cardiovascular disease.
Is early-phase BNP-cGMP cascade activation associated with left ventricular reverse remodelling and long-term outcomes in patients with anterior acute myocardial infarction?
Cohort (n=67)
Is early-phase BNP-cGMP cascade activation associated with left ventricular reverse remodelling and long-term outcomes in patients with anterior acute myocardial infarction?
Early-phase activation of the BNP-cGMP cascade is associated with left ventricular reverse remodelling, which in turn predicts better long-term clinical outcomes after anterior AMI.
Supports risk stratification by early BNP-cGMP response after anterior AMI; leaves open causal therapeutic implications requiring prospective trials.
BACKGROUND: The role of cyclic guanosine 3',5'-monophosphate (cGMP) after acute myocardial infarction (AMI) is not well understood despite its significance as a second messenger of natriuretic peptides (NPs) in cardiovascular disease. We investigated the association between the NP-cGMP cascade and left ventricular reverse remodelling (LVRR) in anterior AMI. METHODS: 67 patients with their first anterior AMI (median age, 64 years; male, 76%) underwent prospective evaluation of plasma concentrations of the molecular forms of A-type and B-type natriuretic peptide (BNP) and cGMP from immediately after primary percutaneous coronary intervention (PPCI) to 10 months post-AMI. The estimated mature BNP (emBNP) concentration was calculated as the difference between total BNP and prohormone of BNP (proBNP) concentrations. Patients were divided into LVRR and non-LVRR groups on the basis of residuals between observed change in left ventricular end-systolic volume index on MR during the first 11 months after AMI and change adjusted for proBNP concentration immediately post-PPCI, which was calculated with regression. The LVRR group (n=33) had residuals below the median; the non-LVRR group (n=34) had residuals at or above the median. RESULTS: The LVRR group had higher freedom from major adverse cardiac and cerebrovascular events (MACCEs) than the non-LVRR group during a median follow-up of 9.9 years (p=0.008). The presence of LVRR (HR 0.256; 95% CI 0.081 to 0.809; p=0.028) and peak creatine phosphokinase-myocardial band level (per 100 IU/L) (HR 1.22; 95% CI 1.02 to 1.46; p=0.027) were independent predictors of MACCE after adjusting for age, male sex, infarct size and hypertension. Multivariable analyses identified logarithmic proBNP and emBNP concentrations from 12 hours to 5 days post-AMI and logarithmic cGMP concentration from immediately post-PPCI to 3 days post-AMI as independent predictors of LVRR (p<0.05). CONCLUSIONS: Early-phase BNP-cGMP cascade activation might play a crucial role in LVRR in anterior AMI.
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Arai et al. (2025) conducted a cohort in Anterior acute myocardial infarction (n=67). Left ventricular reverse remodelling (LVRR) vs. Non-LVRR was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) (HR 0.256, 95% CI 0.081 to 0.809, p=0.028). Early-phase BNP-cGMP cascade activation predicted left ventricular reverse remodelling, which was associated with a lower risk of MACCEs (HR 0.256; 95% CI 0.081-0.809; p=0.028).
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