Ventricular endocrine and mechanical function following thrombolysis for acute myocardial infarction.
OBJECTIVE
The objective of this study was to assess natriuretic peptide release following acute myocardial infarction, and its relationship with ventricular function.


METHODS
A total of 44 patients with acute myocardial infarction were studied; 13 anterior, age (57+/-12 years) and 31 inferior, age (58+/-12 years). Peptide levels and left ventricular function by echocardiography were assessed at admission and on days 7 and 30 after thrombolysis. Healthy volunteers (n=21) served as controls.


RESULTS
Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) levels rose from admission to day 7 (p=0.002). While ANP remained elevated at day 30 in both groups, BNP levels fell in patients with anterior myocardial infarction (p=0.03). Left ventricular fractional shortening was reduced at admission in the two groups (p=0.01) but returned towards normal in 7 days (p=0.001) in inferior myocardial infarction and in 30 days in anterior myocardial infarction (p=0.02). Left ventricular long axis amplitude was universally reduced at admission (p=0.01) and remained abnormal at day 30 (p=0.01) in both groups. At day 7, BNP and ANP levels inversely correlated with long axis amplitude of lateral wall in anterior myocardial infarction; (r=-0.7, p=0.01). BNP correlated inversely with fractional shortening in anterior myocardial infarction (r=-0.7, p=0.01) at day 30.


CONCLUSIONS
The elevated peptide levels at 7 days post-myocardial infarction correlate with reduced mechanical activity of the adjacent noninfarcted segment. Natriuretic peptides release seem to be related to failure of compensatory hyperdynamic activity of the noninfarcted area rather than directly from the injured myocardial segments.
Ramzy
Ihab S
IS
Central Middlesex Hospital, Cardiology Department, London, UK.
Daly
Caroline A
CA
O'Sullivan
Christine A
CA
Lam
Yat-Yin
YY
Kemp
Michael
M
Hooper
James
J
Dancy
Mark
M
Henein
Michael Y
MY
D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000145:classification / Q000503:physiopathology* / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016276:Ventricular Function
D015415:Biomarkers; D005343:Fibrinolytic Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D010959:Tissue Plasminogen Activator