ABC | Volume 113, Nº6, December 2019

Original Article Celebi et al. NT-pro BNP and left ventricular aneurysm Arq Bras Cardiol. 2019; 113(6):1129-1137 The aim of this study was to evaluate the value of admission NT-pro BNP level in predicting LVA after acute STEMI. Methods A total of 1,519 consecutive acute STEMI patients admitted to our department were enrolled in this study from June 2011 to January 2017. The protocol for the study was approved by the local ethics committee. The study complied with the Declaration of Helsinki guidelines. Written informed consent was obtained from all patients. The eligibility criteria included patients aged 21 to 75 years who presented within 12 h of chest pain. The exclusion criteria included previous heart failure, shock, pulmonary edema requiring intubation, and creatinine clearance < 30 ml/min. Acute STEMI was defined according to the third universal definition of myocardial infarction. 9 Demographic information was collected, and a physical examination was performed for each patient. A 16-lead electrocardiogram recording was obtained from each patient immediately after admission. Two-dimensional transthoracic echocardiography (TTE) was performed in all patients at admission and at the end of the first and sixmonths of the index acute STEMI. The TTEmeasurements were performed using a Vivid 7 system (Vivid 7, GE Vingmed Ultrasound, Horten, Norway). The echocardiographic assessment was performed according to a previous study by Weyman et al. 10 Complete 2-dimensional TTE, including Doppler flow interrogation, was performed according to standard techniques. LVA was defined as a demarcated bulge of the contour of the left ventricular wall during both diastole and systole, which showed akinesia and dyskinesia. Blood samples were obtained immediately after admission to the coronary care unit using EDTA-containing tubes. The samples were stored for 3 days prior to NT-pro BNP assessment. Plasma NT-pro BNP level was measured using the Roche Diagnostics ElecsysproBNPelectrochemiluminescence immunoassay (ElecsysproBNP; Roche Diagnostics, Indianapolis, Ind). Baseline serum creatinine clearance was estimated using the Cockcroft–Gault formula. Fasting blood samples were taken in the morning after admission to determine fasting glucose and blood lipids. Blood samples for troponin I and creatine kinase‑MB (CK-MB) assessment were taken every 8 h during the first 3 days after admission. The peak troponin and CK-MB levels during the hospital stay were also collected. Reperfusion was achieved with primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy. The choice of reperfusion therapy type was made according to the patient’s condition and the center’s capabilities. Patients who were not suitable for reperfusion therapy because of late admission, comorbidities or contra‑indications were followed medically. All patients underwent coronary angiography except patients with serious comorbidities or contra-indications. Selective left and right coronary angiography was performed using the Judkins technique. Left ventriculography was performed in the 30° right anterior oblique and 60° left anterior oblique projections and left ventricular end-diastolic pressure was measured before ventriculography. The Rentrop grading scale was used to quantify the extent of collateral filling. The most opacified projection was used for grading. The following values were assigned according to the scale: 0 = no visible filling of any collateral vessel or collateral channels, 1 = filling of side branches of the artery to be perfused by collateral vessels without visualization of the epicardial segment, 2 = partial filling of the epicardial artery by collateral vessels, or 3 = complete filling of the epicardial artery by collateral vessels. The mean collateral score was then calculated by dividing the sum of the Rentrop numbers by the number of patients. The Gensini score was used to evaluate coronary lesion severity. Gensini score calculation was initiated by giving a severity score to each coronary stenosis as follows: 1 point for ≤ 25% narrowing, 2 points for 26 to 50% narrowing, 4 points for 51 to 75% narrowing, 8 points for 76 to 90% narrowing, 16 points for 91 to 99% narrowing, and 32 points for total occlusion. Thereafter, each lesion score was multiplied by a factor that considered the importance of the lesion's position in the coronary circulation (5 for the left main coronary artery; 2.5 for the proximal segment of the left anterior descending coronary artery; 2.5 for the proximal segment of the circumflex artery; 1.5 for the mid-segment of the left anterior descending coronary artery; 1.0 for the right coronary artery, the distal segment of the left anterior descending coronary artery, the posterolateral artery, or the obtuse marginal artery; and 0.5 for the other segments). Finally, the Gensini score was calculated by the summation of the individual coronary segment scores in each group. PPCI performed only for the culprit artery. Percutaneous coronary intervention (PCI) was performed for non-culprit stenotic lesions during index hospitalization. Patients who received fibrinolytic therapy and subsequently underwent coronary angiography, ad hoc PCI was performed in patients with suitable coronary anatomy, and drug-eluting stents were used in most of the patients. In patients without suitable coronary anatomy for PCI, medical therapy or coronary artery bypass graft were decided. All patients received aspirin (300-500 mg), a loading dose of clopidogrel (300-600 mg), and a bolus of unfractionated heparin (60-100 U/kg). At discharge, medical therapy was prescribed according to the patient’s individual status and guideline recommendations for secondary prevention. 11 The patients were divided into two groups according to the presence of LVA within the six months of index MI. Group 1 consisted of patients with LVA, and group 2 included those without LVA. Statistical analysis Statistical analysis was performed using IBM SPSS Statistics 22.0 statistical software. Continuous variables with normal distribution were reported as the mean ± standard deviation, continuous variables with non-normal distribution were reported as median –interquartile range and categorical variables were expressed as the number of patients and percentages. Normality was tested using the Kolmogorov‑Smirnov test. Comparisons between categorical variables were performed by the Pearson’s chi-square test, or Fisher’s exact test, as 1130