Association between left ventricular reverse remodelling and the B-type natriuretic peptide-cGMP cascade after anterior acute myocardial infarction.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-01-11 DOI:10.1136/openhrt-2024-002927

Marina Arai, Yasuhide Asaumi, Satoshi Honda, Soshiro Ogata, Eri Kiyoshige, Kazuhiro Nakao, Hiroyuki Miura, Yoshiaki Morita, Takahiro Nakashima, Kota Murai, Takamasa Iwai, Kenichiro Sawada, Hideo Matama, Masashi Fujino, Hiroyuki Takahama, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yu Kataoka, Kunihiro Nishimura, Teruo Noguchi, Naoto Minamino, Satoshi Yasuda

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引用次数: 0

Abstract

Background: The role of cyclic guanosine 3',5'-monophosphate (cGMP) after acute myocardial infarction (AMI) is not well understood despite its significance as a second messenger of natriuretic peptides (NPs) in cardiovascular disease. We investigated the association between the NP-cGMP cascade and left ventricular reverse remodelling (LVRR) in anterior AMI.

Methods: 67 patients with their first anterior AMI (median age, 64 years; male, 76%) underwent prospective evaluation of plasma concentrations of the molecular forms of A-type and B-type natriuretic peptide (BNP) and cGMP from immediately after primary percutaneous coronary intervention (PPCI) to 10 months post-AMI. The estimated mature BNP (emBNP) concentration was calculated as the difference between total BNP and prohormone of BNP (proBNP) concentrations. Patients were divided into LVRR and non-LVRR groups on the basis of residuals between observed change in left ventricular end-systolic volume index on MR during the first 11 months after AMI and change adjusted for proBNP concentration immediately post-PPCI, which was calculated with regression. The LVRR group (n=33) had residuals below the median; the non-LVRR group (n=34) had residuals at or above the median.

Results: The LVRR group had higher freedom from major adverse cardiac and cerebrovascular events (MACCEs) than the non-LVRR group during a median follow-up of 9.9 years (p=0.008). The presence of LVRR (HR 0.256; 95% CI 0.081 to 0.809; p=0.028) and peak creatine phosphokinase-myocardial band level (per 100 IU/L) (HR 1.22; 95% CI 1.02 to 1.46; p=0.027) were independent predictors of MACCE after adjusting for age, male sex, infarct size and hypertension. Multivariable analyses identified logarithmic proBNP and emBNP concentrations from 12 hours to 5 days post-AMI and logarithmic cGMP concentration from immediately post-PPCI to 3 days post-AMI as independent predictors of LVRR (p<0.05).

Conclusions: Early-phase BNP-cGMP cascade activation might play a crucial role in LVRR in anterior AMI.

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前路急性心肌梗死后左心室反向重构与b型利钠肽- cgmp级联的关系

背景：环鸟苷3′，5′-单磷酸（cGMP）在急性心肌梗死（AMI）后的作用尚不清楚，尽管它是利钠肽（NPs）在心血管疾病中的第二信使。我们研究了NP-cGMP级联与AMI前期左心室反向重构（LVRR）的关系。方法：67例首次前路AMI患者(中位年龄64岁；男性，76%)在首次经皮冠状动脉介入治疗（PPCI）后立即至ami后10个月，对a型和b型利钠肽（BNP）和cGMP分子形式的血浆浓度进行前瞻性评估。估计的成熟BNP （emBNP）浓度计算为总BNP和BNP激素原（proBNP）浓度之差。根据AMI后前11个月MR左室收缩末期容积指数变化与ppci后立即调整proBNP浓度变化的差值，将患者分为LVRR组和非LVRR组，并进行回归计算。LVRR组（n=33）的残差低于中位数；非lvrr组（n=34）的残差等于或高于中位数。结果：在中位随访9.9年期间，LVRR组的主要心脑血管不良事件（MACCEs）发生率高于非LVRR组（p=0.008）。LVRR的存在(HR 0.256；95% CI 0.081 ~ 0.809；p=0.028)和峰值肌酸磷酸激酶-心肌带水平（每100 IU/L） (HR 1.22；95% CI 1.02 ~ 1.46；p=0.027)是校正年龄、男性、梗死面积和高血压后MACCE的独立预测因子。多变量分析发现，AMI后12小时至5天的对数proBNP和emBNP浓度以及ppci后立即至AMI后3天的对数cGMP浓度是LVRR的独立预测因子(结论：早期BNP-cGMP级联激活可能在AMI前期LVRR中起关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.