title: Brain natriuretic peptide in acute myocardial infarction: a marker of cardio-renal interaction.
abstract: OBJECTIVE
  Cardiac and renal functions are major independent predictors of outcomes in both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). As B-type natriuretic peptide (BNP) seems to be a major mediator in the cross-talk between heart and kidneys, we aimed at evaluating its capacity to reflect cardiac and renal function in patients with STEMI and NSTEMI.
  
  
  METHODS
  We measured BNP plasma levels at hospital admission in 619 patients with STEMI (n = 346) and NSTEMI (n = 273), grouped according to left ventricular ejection fraction (LVEF; > or ≤40%) and estimated glomerular filtration rate (eGFR; > or ≤ 60 ml/min/1.73 m).
  
  
  RESULTS
  Median BNP values were 82 (38-186), 121 (40-342), 219 (80-685), and 474 (124-1263) pg/ml in patients with normal LVEF and eGFR (n = 347), with LVEF 40% or less and eGFR higher than 60 ml/min/1.73 m (n = 120), with LVEF higher than 40% and eGFR 60 ml/min/1.73 m or less (n = 86), and with combined LVEF and eGFR reductions (n = 66), respectively (P < 0.0001). At general linear model, both LVEF higher than 40% (P < 0.0001) and eGFR 60 ml/min/1.73 m or less (P < 0.0001) independently predicted BNP values. At multivariable analysis, BNP, LVEF 40% or less, and eGFR 60 ml/min/1.73 m or less were found to be independent predictors of the combined end point of in-hospital death, cardiogenic shock, need for renal replacement therapy, or mechanical ventilation (P = 0.003; P < 0.0001; P = 0.01, respectively).
  
  
  CONCLUSIONS
  BNP plasma levels are closely related to LVEF and eGFR at hospital admission, in both STEMI and NSTEMI patients. Future studies should investigate whether BNP levels can summarize in a single parameter the prognostic information provided separately by cardiac and renal dysfunction.
authors.affiliation: aCentro Cardiologico Monzino, I.R.C.C.S, Milan, Italy bDivision of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: Moltrasio
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.forename: Monica
authors.initials: M
authors.lastname: De Metrio
authors.forename: Mara
authors.initials: M
authors.lastname: Rubino
authors.forename: Angelo
authors.initials: A
authors.lastname: Cabiati
authors.forename: Valentina
authors.initials: V
authors.lastname: Milazzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Discacciati
authors.forename: Ivana
authors.initials: I
authors.lastname: Marana
authors.forename: Alice
authors.initials: A
authors.lastname: Bonomi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Lauri
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006321:Heart / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000097:blood*; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain