BRAIN NATRIURETIC PEPTIDE AS AN INDICATOR OF LEFT VENTRICLE DYSFUNCTION AND A PREDICTOR OF CARDIOVASCULAR EVENTS IN ACUTE CORONARY SYNDROMES
ABSTRACT: Acute coronary
syndromes can cause systolic and diastolic left ventricle (LV) dysfunction.
Determination of LV dysfunction in ACS provides benefit to stratification and
optimizing therapy. Brain Natriuretic Peptide (BNP) is secreted primarily from
and synthesized in left ventricle in response to increased myocardial stretch.
BNP increase in heart failure. BNP increase in the 24 hours in acute myocardial
infarction. We hypothesized that BNP level could be as an indicator of systolic
and diastolic dysfunction and a predictor of cardiovascular events in acute
coronary syndromes. Objective: To investigate plasma level of BNP in systolic
and diastolic dysfunction in acute coronary syndromes hospitalized to ICCU. To
investigate plasma level of BNP as a predictor of cardiovascular events in
acute coronary syndromes. Method and
Result: We measured BNP in plasma
specimen obtained 3 days after the onset of ischemic symptoms in 25 patients of
acute coronary syndromes and prospectively followed the patients for 30 days.
Patients diagnosed with evidence of systolic LV dysfunction had a mean BNP
concentration of 301.11 ± 189.62 pg/ml, higher than those patients with normal
LV function (42.67 ± 22.44 pg/ml, p =
0.003). Patients diagnosed with evidence of diastolic LV dysfunction had a mean
BNP concentration of 273.70 ± 146.27
pg/ml, higher than those patients with normal LV function (42.67 ± 22.44 pg/ml, p = 0.006). Patients with cardiovascular events had a mean BNP concentration
of 392.30 ± 157.14 pg/ml, higher than patients without cardiovascular events
(118.67 ± 78.53 pg/ml, p < 0.0001). In patients with cardiovascular events,
minimum plasma BNP level (248 pg/ml) was higher than maximum plasma BNP level
in patients without cardiovascular events (234 pg/mL). Conclusion: Plasma BNP level can reliably detect
the presence of diastolic or systolic LV dysfunction on echocardiography in
acute coronary syndromes. Moreover, plasma BNP level can also predict patients
with cardiovascular events in 30-days after acute coronary syndromes.
Author: Nugroho, M. Yogiarto
Journal Code: jpkedokterangg050033
