Reference Values and Release Kinetics of B-Type Natriuretic Peptide Signal Peptide in Patients with Acute Myocardial Infarction.
BACKGROUND
The signal peptide for human B-type natriuretic peptide preprohormone (BNPsp), which is released from cardiomyocytes, is increased in plasma of patients with acute myocardial infarction (AMI); however, its exact release kinetics have not been defined.


METHODS
We measured BNPsp and high-sensitivity cardiac troponin T (hs-cTnT) in a reference group of individuals without structural heart disease (n = 285) and determined the release kinetics of these biomarkers in patients (n = 29) with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a procedure allowing exact timing of onset of iatrogenic AMI. Blood samples were collected before TASH and at numerous preselected time points after TASH.


RESULTS
The reference median BNPsp concentration was 53.4 pmol/L [interquartile range (IQR) 47.0-61.0; 95th percentile 85.9 pmol/L; 99th percentile 116.3 pmol/L]. Baseline concentrations in patients undergoing TASH were higher than in the reference group [91.9 pmol/L (IQR 62.9-116.4); P < 0.0001]. BNPsp increased significantly, peaking at 15 min after induction of AMI [149.6 pmol/L (109.5-204.9) vs baseline; P = 0.004] and declining slowly thereafter, falling below the preprocedural value after 8 h (P = 0.014). hs-cTnT increased significantly 15 min after induction of AMI [26 ng/L (19-39) vs 18 ng/L (11-29); P = 0.001] and remained high at all later time points.


CONCLUSIONS
BNPsp concentrations increased immediately after AMI induction, providing early evidence of myocardial injury. The release kinetics of BNPsp differed from those of hs-cTnT. These findings provide information that should help in establishing the diagnostic value of BNPsp in the setting of early AMI.
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany; c.liebetrau@kerckhoff-klinik.de.
Christoph
C
Liebetrau
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Luise
L
Gaede
Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany;
Oliver
O
Dörr
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Johannes
J
Blumenstein
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Stefanie
S
Rosenburg
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Jedrzej
J
Hoffmann
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Christian
C
Troidl
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany; Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany;
Christian W
CW
Hamm
Department of Internal Medicine I, Division of Cardiology, University of Giessen, Giessen, Germany;
Holger M
HM
Nef
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany;
Helge
H
Möllmann
Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore.
A Mark
AM
Richards
Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand;
Chris J
CJ
Pemberton
D055011:Ablation Techniques; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002312:Cardiomyopathy, Hypertrophic / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D006346:Heart Septum / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D032383:Myocytes, Cardiac / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D021382:Protein Sorting Signals; D012016:Reference Values; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D021382:Protein Sorting Signals; D020107:Troponin T; D020097:Natriuretic Peptide, Brain