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

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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.