N-terminal proatrial natriuretic peptide predicts two-year remodelling in patients with acute transmural myocardial infarction

Aims To evaluate whether baseline N-terminal proatrial natriuretic peptide (Nt-proANP) or Doppler echocardiographic parameters could predict two-year left ventricular remodelling after acute myocardial infarction in patients without heart failure. Methods and results Seventy-one patients were followed with Doppler echocardiographic examinations at baseline, 3 months, 1 and 2 years, and Nt-proANP was measured at baseline and 3 months. After 2 years there was a significant increase in end-diastolic volume index of 11% (p = 0.006) and end-systolic volume index of 14% (p = 0.03), and no Change in ejection fraction. This remodelling was confined to 12 patients (17%) with a significant increase in end-diastolic volume index above 20 ml/ m(2). Baseline Nt-proANP (p < 0.0005), 3-month changes in end-diastolic volume index (p = 0.007), and 3-month E/A ratio (p = 0.014) were independent positive predictors for two-year changes in end-diastolic volume index. Two-year dilatation above 20 ml/ m(2) was predicted by baseline Nt-proANP (p = 0.014) and maximal velocity of systolic pulmonary venous flow (p = 0.034). Conclusion Seventeen percent of patients with transmural myocardial infarction and no baseline heart failure experienced a significant left ventricular dilatation at 2 years, and this was best predicted by baseline Nt-proANP. Unstructured abstract Seventy-one patients with acute myocardial infarction and no heart failure were followed for two years in an observational Doppler echocardiographic study. There was a significant increase in end-diastolic volume index of 11% (p = 0.006) and end-systotic volume index of 14% (p = 0.03), but no change in ejection fraction after two years. Nt-proANP was the strongest independent predictor of two-year changes in end-diastolic volume index and of an increase in end-diastolic volume index above 20 ml/m(2) after two years. (C) 2004 Published by Elsevier Ltd on behalf of The European Society of Cardiology.