Differences of Serum NT-PROBNP Concentration and Echocardiographic Parameterspredict Extent and Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Introduction: Plaque disruption exposes thrombogenic substances that may produce an extensive thrombus in the infarct-related artery. The precursor of BNP and N-terminal pro – Brain Natriuretic Peptide (NT-proBNP) is a pre-pro hormone BNP, The prohormone is released during homodynamic stress from the left and right cardiac ventricle in response to ventricular volume expansion and pressure overload. Recent data suggest that left ventricular end diastolic wall stress and wall stiffness may be the predominate triggers of BNP release. Objective: To determine the level of serum NT-PRO brain natriuretic peptide which marked an increased incidence of cardiovascular events in unselected community-based individuals with many types of acute coronary syndrome admitted to cardiology care unite within 24 hour. Patients and Methods: This prospective study was composed of 70 consecutive patients with ACS who were seen between April 2015 to April 2017, and 20 healthy subjects as control group. The present study was conducted at the Department of Bio Chemistry, College of Medicine, University of Baghdad and Baghdad Teaching Hospital. Routine blood samples were collected at admission with fasting status, and the troponin I, C-reactive protien , and BNP levels were measured, a specific kit for the ELIZA Centaur analyzer was used. Glucose level was measured by using enzymatic colorimetric method. the patients were divided into five groups according to type of ACS: Extensive MI, Anteroseptal MI, Anterior MI, Inferior MI, and Unstable angina. Electrocardiography and Echocardiography were performed upon hospital admission for each patient. Results: This study included 70 patients with mean±SD of age was (58.77±11.45) years ranged from (25-84) years divided into two groups: Male group included 52(74.3%) patients, and female group included 18 (25.7%) patients. The patients with ACS were found to have significantly higher mean (± SEM) value of serum NTPROBNP concentrations (p=0.0144) as compared with mean (± SEM) value of serum control group, There was significant difference in mean ( SEM) value of NT-PROBNP concentrations among the five patients groups,(P-value=0.0255). The patients with ACS were found to have significantly higher mean (±SEM) value of serum hs-CRP concentrations (p=0.002) as compared with mean (±SEM) value of serum control group. There was significant difference in mean( SEM) value of hs-CRP concentrations among the five patients groups, (Pvalue=0.0478). The mean (±SEM) value of serum hs-troponin I concentrations did not differ significantly (p=0.372) as compared with mean (±SEM) value of serum control group. There was non significant difference in mean( SEM) value of serum hs-troponin I concentrations among the five patients groups,(P-value=0.146). Conclusions: Analysis of NT-proBNP help emergency physicians in managing patients with a variety of conditions. They are primarily helpful in difficult-to-diagnose causes of dyspnea. They are a strong tool in the ED to differentiate ACS from its various mimics and are also helpful in monitoring of ACS therapy.