title: Predictors of Left Ventricle Remodeling: Combined Plasma B-type Natriuretic Peptide Decreasing Ratio and Peak Creatine Kinase-MB.
abstract: Background:Previous studies reported that patients who had an acute myocardial infarction (AMI) have found that measuring B-type natriuretic peptide (BNP) during the subacute phase of left ventricular (LV) remodeling can predict the possible course of LV remodeling. This study assessed the use of serial BNP serum levels combined with early creatine kinase-MB (CK-MB) to predict the development of significant LV remodeling in AMI patients.Methods:Nighty-seven patients with new onset AMI were assessed using serial echocardiographic studies and serial measurements of BNP levels, both performed on day-2 (BNP1), day-7 (BNP2), day-90 (BNP3), and day-180 (BNP4) after admission. LV remodeling was defined as >20% increase in biplane LV end-diastolic volume on day-180 compared to baseline (day-2).Results:Patients were divided into LV remodeling [LVR(+)] and non LV remodeling [LVR(-)] groups. No first-week BNP level was found to predict remodeling. However, the two groups had significantly different day-90 BNP level (208.1 ± 263.7 pg/ml vs. 82.4 ± 153.7 pg/ml, P = 0.039) and significantly different 3-month BNP decrease ratios (RBNP13) (14.4 ± 92.2% vs. 69.4 ± 25.9%, P < 0.001). The appropriate cut-off value forRBNP13was 53.2% (AUC = 0.764, P < 0.001). Early peak CK-MB (cut-off 48.2 ng/ml; AUC = 0.672; P = 0.014) was another independent predictor of remodeling. Additionally, combining peak CK-MB andRBNP13offered an excellent discrimination for half-year remodeling when assessed by ROC curve (AUC = 0.818, P < 0.001).Conclusion:RBNP13is a significant independent predictor of 6-month LV remodeling. The early peak CK-MB additionally offered an incremental power to the predictions derived from serial BNP examinations.
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Jen-Te
authors.initials: JT
authors.lastname: Hsu
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Chung
authors.affiliation: Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taiwan.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Chu
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Yu-Shen
authors.initials: YS
authors.lastname: Lin
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Kuo-Li
authors.initials: KL
authors.lastname: Pan
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Jung-Jung
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Wang
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Shih-Tai
authors.initials: ST
authors.lastname: Chang
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Teng-Yao
authors.initials: TY
authors.lastname: Yang
authors.affiliation: The Department of Cardiology, Taipei Tzu Chi General Hospital, Taiwan.
authors.forename: Shih-Jung
authors.initials: SJ
authors.lastname: Jang
authors.affiliation: Department of Laboratory Medicine, Chang-Gung Medical Foundation.
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Yang
authors.affiliation: The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
authors.forename: Ju-Feng
authors.initials: JF
authors.lastname: Hsiao
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form
keywords: B-type Natriuretic Peptide (BNP); BNP decrease ratio; acute myocardial infarction (AMI); left ventricular remodeling; peak creatine kinase-MB.