Effects Of Intravenous Recombinant Human Brain Natriuretic Peptide On Ventricular Remodeling And Prognosis In Acute Anterior Myocardial Infarction With Heart Failure

Objective: To evaluate the effects of intravenous recombinant humanbrain natriuretic peptide on ventricular remodeling and prognosis in acuteanterior myocardial infarction with heart failure.Methods: From June2012to June2013,49patients who were admittedto our department after the out-of-hospital thrombolysis because of first acuteanterior myocardial infarction with acute heart failure (Killip II-III) within24-48h were enrolled in this study. All eligible patients were randomized intotwo groups:rhBNP group (24patients) and routine treatment (RT) group (25patients). In RT group, diuretics, nitrates and digitalis were administered tocontrol heart failure, besides, standard medications including anticoagulation,antiplatelet were administered. While in rhBNP group, rhBNP (loading dose:1.5μg/kg intravenous bolus injection; maintenance dose:0.0075-0.025μg/kg/min for the following72h) was administered on the basis of standardmedications(except diuretics and nitrates). After patients conditions becomingstable,all the patients underwent CAG to confirm IRA, according to the resultsof angiography, PCI was performed if IRA significant stenosis beyond75%ofthe diameter. According to the initial TIMI flow, rhBNP group and RT groupwere separated to two subgroups: reperfusion group: TIMI flow grade3,no-reperfusion group: TIMI flow grade0-2.So all the patients were finallyseparated to four groups: group A: rhBNP+TIMI flow grade3; group B:rhBNP+TIMI flow grade0-2; group C:RT+TIMI flow grade3;groupD:RT+TIMI flow grade0-2.NT-proBNP levels, echocardiographicparameters and major adverse cardiac events were recorded in detail beforeadministration, at1-and6-month f/u. Echocardiographic parameters(LVEF,LVESVI, LVEDVI,RWMI) were to illustrate the extent of ventricular remodeling. The major adverse cardiac events (MACE) including cardiacdeaths, recurrent nonfatal myocardial infarction, angina post myocardialinfarction, heart failure NYHA≥Ⅲ, malignant arrhythmia(shortlyparoxysmal ventricular tachycardia), were to reflect the clinical long-termprognosis. All the data were analyzed under the aid of SPSS19.0. P<0.05(2-sided) was defined as statistically significant.Results:1Comparison of baseline characteristics: Between group A and group C,group B and group D,there were no significant differences in baselinecharacteristics,such as age, sex and risk factors (hypertension, diabetes,dyslipidemia, smoking history), heart rate, blood pressure, Killip class, peakCK-MB, SCr, GRACE score, CRUSADE score, basic medications (allP>0.05).2Comparison of CAG and PCI characteristics: The following indicatorsincluding the proportion of multivessel disease, TIMI pre-stents,TIMIpost-stents, TMPG post-stents,number of stents per patient were notstatistically different between group A and group C, group B and group D，(allP>0.05).3Comparison of echocardiographic parameters:There were no significant differences in LVEF,LVESVI,LVEDVI,RWMIbefore administration in two subgroups.(P all>0.05).At1-month f/u, LVEF was significantly higher than that beforeadministration, LVEF in group A was higher than that in group C (44.9±2.1%vs42.9±2.3%，P<0.05), there was signifcant difference between the twogroups, while there was a trend of higher LVEF in group B than that in groupD, no signifcant difference.The following echocardiographic parametersincluding LVESVI, LVEDVI and RWMI in reperfusion subgroup of rhBNPgroup were statistically different compared with that before administration andthose in group A were more lower than that in group C (42.3±2.5ml/m2vs44.5±2.8ml/m2,76.5±4.6ml/m2vs80.5±4.9ml/m2,2.44±0.23vs2.65±0.27，P all <0.05), while there was a trend of lower LVESVI, LVEDVI and RWMI in group B than that in group D, no signifcant difference.At6-month f/u, LVEF was significantly higher than that beforeadministration, LVEF in group A was higher than that in group C (48.5±3.8%vs45.5±3.1%，P <0.05), there was signifcant difference between thetwo groups, while there was a trend of higher LVEF in group B than that ingroup D, no signifcant difference. LVESVI, LVEDVI and RWMI in the twogroups were significantly lower than that before administration and those ingroup A were more lower than that in group C (33.5±3.3ml/m2vs37.5±3.3ml/m2,68.5±4.9ml/m2vs73.1±5.3ml/m2,1.65±0.32vs1.95±0.36，P all<0.05), while there was a trend of lower LVESVI, LVEDVI and RWMI ingroup B than that in group D, no signifcant difference.4Comparison of NT-proBNP levels:At1-month f/u, the levels of NT-proBNP in the two groups weresignificantly lower than that at baseline. The level of NT-proBNP in group Awas significantly lower than that in group C (617.60±143.60pg/ml vs860.42±172.57pg/ml, P <0.05), while there was a trend of lower NT-proBNPin group B than that in group D (1060.72±232.87pg/ml vs1223.80±256.69pg/ml, P=0.058), no signifcant difference.At6-month f/u, the levels of NT-proBNP in the two groups weresignificantly lower than that at baseline. The level of NT-proBNP in group Awas significantly lower than that in group C (320.06±41.13pg/ml vs433.33±64.79pg/ml, P <0.05)，while there was a trend of lower NT-proBNPin group B than that in group D (586.75±59.32pg/ml vs628.35±62.71pg/ml,P=0.052), no signifcant difference.5Comparison of MACE incidence:At6-month f/u,there was1recurrentnonfatal myocardial infarction,1angina post myocardial infarction in groupA,while1recurrent nonfatal myocardial infarction,2angina post myocardialinfarction,2heart failure NYHA≥Ⅲ in group C; there was1malignantarrhythmia(shortly paroxysmal ventricular tachycardia),1recurrent nonfatalmyocardial infarction,1angina post myocardial infarction,3heart failureNYHA≥Ⅲ in group B,while1malignant arrhythmia(shortly paroxysmal ventricular tachycardia),1recurrent nonfatal myocardial infarction,2anginapost myocardial infarction,4heart failure NYHA≥Ⅲ in group D.Conclusion: Intravenous recombinant human brain natriuretic peptide onthe basis of standard medication in acute anterior myocardial infarction withheart failure after successful thrombolysis can further inhibit the ventricularremodeling, enhance the left ventricular function, and improve the prognosisat6month f/u.