Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction

OBJECTIVE: To investigate the relation between brain natriuretic peptide (BNP) concentrations and left ventricular remodelling characteristics after acute myocardial infarction. DESIGN: Consecutive sample prospective cohort study. SETTING: District general hospital coronary care unit in the north of England. PATIENTS: 133 initial survivors of a first myocardial infarction who received thrombolytic treatment. INTERVENTIONS: Patients had transthoracic echocardiography and BNP concentrations measured at three to seven days (early) and two months (late). MAIN OUTCOME MEASURES: Wall motion index </= 1.2, end systolic left ventricular volume index and mortality at one year. RESULTS: Patients with an early wall motion index of </= 1.2 had higher early and late BNP concentrations (early BNP mean (SEM) 629 (76.2) pg/ml v 334 (20.8) pg/ml, p = 0.001 and late BNP 584 (79.5) pg/ml v 343 (25.0) pg/ml, p = 0.001). Patients with an increase in end systolic left ventricular volume index of > 10% also had higher early and late BNP concentrations (early BNP p = 0.034 and late BNP p = 0.001). Early BNP was significantly associated with one year mortality (p = 0.003). CONCLUSIONS: Higher BNP concentrations early after first myocardial infarction are associated with adverse left ventricular remodelling characteristics. This may help explain why BNP is such a strong predictor of outcome after myocardial infarction.