Changes in vasoconstrictive hormones, natriuretic peptides, and left ventricular remodeling soon after anterior myocardial infarction.
OBJECTIVE
Our purpose was to study the changes in vasoconstrictive neurohormones, N-terminal proatrial natriuretic peptide (Nt-proANP), and brain natriuretic peptide (BNP) and their relationship with left ventricular (LV) remodeling soon after anterior myocardial infarction (MI).


BACKGROUND
The Healing and Afterload Reducing Therapy (HEART) trial has shown that early use of ramipril improves left ventricular ejection fraction (LVEF) and attenuates LV remodeling when initiated soon after MI. This neurohumoral substudy of HEART investigates the changes in vasoconstrictive and natriuretic peptides and their relationship with LV remodeling.


METHODS
One hundred twenty-two patients had blood drawn for the measurement of catecholamines, endothelin-I, angiotensin II, Nt-proANP and BNP, and prostacyclins within 24 hours of an MI, and at 3, 14, and 90 days after the MI. Quantitative echocardiograms were performed at baseline and at 14 days.


RESULTS
All neurohormones except angiotensin II (P =.12) and prostaglandins were significantly elevated at baseline. Vasoconstrictive neurohormones decreased significantly over time but remained elevated at 14 days. Both Nt-proANP and BNP were elevated within the first 14 days. BNP decreased significantly by 90 days, whereas Nt-proANP exhibited no change between 14 and 90 days. Ramipril decreased plasma levels of angiotensin II at 3 days but had no effect on the other neurohormones.


CONCLUSIONS
Neurohumoral activation occurs and persists in patients with anterior MI and overall preserved LV function. Ramipril had only a modest impact on neurohormones despite its significant benefits on LV remodeling soon after MI.
White
M
M
Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8. white@icm.umontreal.ca
Rouleau
J L
JL
Hall
C
C
Arnold
M
M
Harel
F
F
Sirois
P
P
Greaves
S
S
Solomon
S
S
Ajani
U
U
Glynn
R
R
Hennekens
C
C
Pfeffer
M
M
D000804:Angiotensin II / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002395:Catecholamines / Q000097:blood*; D004298:Dopamine / Q000097:blood; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D011464:Epoprostenol / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009419:Nerve Tissue Proteins; D009638:Norepinephrine / Q000097:blood; D017257:Ramipril / Q000008:administration & dosage; D013318:Stroke Volume / Q000187:drug effects; D020257:Ventricular Remodeling
D015415:Biomarkers; D002395:Catecholamines; D009419:Nerve Tissue Proteins; D000804:Angiotensin II; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D011464:Epoprostenol; D017257:Ramipril; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine