Do neurohormone levels predict the development of severe heart failure or combined cardiovascular endpoints in asymptomatic survivors of myocardial infarction with LVEF <= 40%?
In asymptomatic post-MI patients with LVEF <= 40%, elevated levels of atrial natriuretic peptide and aldosterone at 3 months are closely associated with the development of severe heart failure and adverse cardiovascular events.
AIMS: To describe the temporal evolution of neurohumoral activation in survivors of myocardial infarction with left ventricular dysfunction who are initially asymptomatic and to relate this to prognosis. METHODS AND RESULTS: Patients in the neurohumoral substudy (n = 534) of the Survival and Ventricular Enlargement (SAVE) study had their neurohormones measured at baseline, 3, 12 and 24 months post-infarction, were followed 38 +/- 7 months and had these values related to prognosis. All patients had a left ventricular ejection fraction 1.96 SD above the mean of age-matched controls), an association between activation of norepinephrine prior to recurrent myocardial infarction (P < 0.001) and combined end-points (P < 0.01) and between activation of aldosterone and severe heart failure (P < 0.05) was identified. CONCLUSIONS: Neurohumoral activation decreases progressively post-infarction, but only in patients with a good prognosis. In patients with a left ventricular ejection fraction < or = 40% and asymptomatic post-infarction plasma atrial natriuretic peptide at 3 months, aldosterone levels appeared to be the neurohormones most closely associated with prognosis. Increased levels of atrial natriuretic peptide, aldosterone and norepinephrine appear to be temporally most closely associated with events.
Pascal Vantrimpont (Thu,) studied this question.