ABC | Volume 113, Nº6, December 2019

Original Article The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction Savas Celebi, 1 Ozlem Ozcan Celebi, 2 Serkan Cetin, 1 Hande Ozcan Cetin, 2 Mujgan Tek, 1 Serkan Gokaslan, 3 Basri Amasyali, 1 Berkten Berkalp, 1 Erdem Diker, 1 Sinan Aydogdu 2 TOBB Ekonomi ve Teknoloji Universitesi – Cardiology, 1 Ankara – Turkey University of Health Science, Turkiye Yuksek Ihtisas Training and Research Hospital – Cardiology, 2 Ankara – Turkey Afyon Kocatepe Universitesi Tip Fakultesi, 3 Afyon – Turkey Mailing Address: Ozlem Ozcan Celebi • University of Health Science, Turkiye Yuksek Ihtisas Training and Research Hospital – Cardiology - TYIH Kardiyoloji Kliniği Sıhhıye Ankara Ankara 06100 – Turkey E-mail: drozlemoz79@yahoo.com Manuscript received September 18, 2018, revised manuscript January 29, 2019, accepted February 13, 2019 DOI: 10.5935/abc.20190226 Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST- segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI. (Arq Bras Cardiol. 2019; 113(6):1129-1137) Keywords: Myocardial Infarction; Coronary Aneurysm/complications; Myocardial Revascularization; Indicators of Morbidity and Mortality; Stroke Volume. Introduction Left ventricular aneurysm (LVA) is an important prognostic marker that is strongly correlated with mortality and morbidity after acute ST-segment elevation myocardial infarction (STEMI). LVA is also strongly related to adverse clinical outcomes. It is well known that LVA carries a high risk of arrhythmia, thromboembolism and heart failure. Additionally, patients with this complication have a high risk of death within 1 year, independent of left ventricular ejection fraction. 1,2 The factors that are associated with LVA after acute STEMI have already been determined. However, most of these studies were performed before the modern treatment era for myocardial infarction. Additionally, the biochemical predictors of this complication have not yet been determined. Early detection prior to the development of LVA may be helpful in the management of patients with acute STEMI. N terminal pro-B-type natriuretic peptide (NT-pro BNP) is a 32-amino acid peptide that is synthesized and released predominantly from the ventricular myocardium in response to myocyte stretching. 3 However, NT-pro BNP is secreted not only in response to increased left ventricular wall stretch but also to myocardial ischemia and infarction. Levels of NT-pro BNP correlate with left ventricular dilatation, remodeling, and dysfunction in patients after acute myocardial infarction. 4 NT-pro BNP concentrations increase rapidly over the first 24 hours after acute myocardial infarction and then tend to stabilize. When measured 1 to 7 days after acute myocardial infarction, NT-pro BNP elevation identifies patients at risk for left ventricular dysfunction, heart failure, and death. 5-8 NT- pro BNP levels after acute myocardial infarction have proven useful for predicting prognosis and estimating infarct size, but the value of NT-pro BNP for the prediction of LVA formation has not yet been determined. 1129