INFLUENCE OF BRAIN NATRIURETIC PEPTIDE DURING ACUTE PHASE ON LEFT VENTRICULAR REMODELING 1 YEAR AFTER MYOCARDIAL INFARCTION

急性期脑钠肽对心肌梗死后1年左心室重构的影响

• 批准号: 10670684
• 负责人: IWASAKA Toshiji
• 金额: $ 2.05万
• 依托单位: KANSAI MEDICAL UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1998
• 资助国家: 日本
• 起止时间: 1998 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-10670684/
• 关键词: natriuretic peptide; myocardial infarction; left ventricular remodeling

Brain natriuretic peptide (BNP) has diuretic and vasodilatatory effect. Increased plasma level of BNP in congestive heart failure is considered as a compensatory mechanism. Large myocardial infarction, which promotes left ventricular (LV) remodeling, was associated with increased level of BNP, whereas it might suppress LV remodeling. To evaluate the influence of plasma BNP level during acute phase on LV remodeling, we studied patients with a first myocardial infarction who were admitted to our cardiovascular center.There were 177 patients who had at least 1 measurement of BNP level during acute phase (day3 or day7 or day14) and 138 patients received echocardiography on day14. There were 63 who had BNP measurement during acute phase with echocardiography on day14 and 1 year after onset of myocardial infarction. Left ventricular remodeling was defined as LV end-diastolic volume index (LVEDVI) 1 year after onset / LVEDVI on day14. BNP level was significantly associated with LV ejection fraction (LVEF) on day14 (r=-0.274〜-0.359) and 1 year after onset (r=-0.255〜-0.304). By the multiple regression analyses adjusted for age, infarction site, reperfusion therapy during acute phase, ACE inhibitor use, and LVEF on day14, any BNP level on day3, day7 or day14 was not associated with LV remodeling in separate models.Increased plasma level of BNP was associated with large infarction evaluated by LVEF.Increased BNP level during acute phase did not reduce LV remodeling 1 year after onset of myocardial infarction. On the other hand, increased BNP level during acute phase did not predict LV remodeling 1 year after onset of myocardial infarction. The cardioprotective effect of BNP was canceled by the effect of large infarction to promote LV remodeling. BNP was not a simple marker of LV remodeling such as cardiac enzymes because of the cardioprotecive effect.

脑钠肽（BNP）具有利尿和舒张血管的作用。充血性心力衰竭时血浆BNP水平升高被认为是一种代偿机制。大面积心肌梗死可促进左室重构，与BNP水平升高相关，而大面积心肌梗死可抑制左室重构。为了评价急性期血浆BNP水平对左室重构的影响，我们对我院心血管中心收治的首次心肌梗死患者进行了研究，其中177例患者在急性期（第3天、第7天或第14天）至少测定了一次BNP水平，138例患者在第14天接受了超声心动图检查。63例患者于发病后14 d和1年分别行急性期超声心动图BNP测定。左心室重构定义为发病后1年的左心室舒张末期容积指数（LVEDVI）/第14天的LVEDVI。BNP水平与发病后第14天（r=-0.274 μ g-0.359）和1年（r=-0.255 μ g-0.304）的左室射血分数（LVEF）显著相关。通过校正年龄、梗死部位、急性期再灌注治疗、ACE抑制剂使用和第14天LVEF的多元回归分析，第3天任何BNP水平，在不同的模型中，第7天或第14天的BNP水平与左室重构无关，血浆BNP水平升高与LVEF评估的大梗死相关，急性期BNP水平升高并不能减少发病后1年的左室重构。心肌梗死另一方面，急性期BNP水平升高不能预测心肌梗死后1年的左室重构。BNP的心肌保护作用被大梗死促进左室重构的作用所抵消。BNP具有保护心脏的作用，不能像心肌酶那样简单地作为左室重构的标志物。