Copyright © 2006, The European Society of Cardiology
Echocardiography V NT-BNP as markers of prognosis post acute myocardial infarction (AMI)
University Hospitals Leicester
Introduction/Aims: All cause mortality and morbidity post AMI are correlated to LV systolic function and both measurements of LV ejection fraction (LVEF) and wall motion index scoring (WMIS) have been shown to have prognostic roles. In recent years NT-BNP has also been shown to be a powerful predictor of outcome. We aimed to compare the prognostic roles of LVEF, WMIS and NT-BNP post acute myocardial infarction.
Methods: We recruited 309 consecutive patients admitted to our coronary care unit with a diagnosis of AMI (80% STEMI, 75% Male). NT-BNP was measured and trans-thoracic echo performed pre-discharge. We measured LVEF via bi-planar rule of discs method and WMIS using a standard 16 segment model. Segments were scored as 0 – hyperkinetic, 1 – normal, 2 – hypokinetic, 3 – akinetic, and 4 – dyskinetic, scores were averaged with higher scores indicating a more impaired ventricle. Our primary end-point was a composite of all cause mortality, heart failure or re-infarction.
Results: During a median follow-up 381 days (range 0–618) there were 35 re-infarcts, 28 heart failure episodes and 26 deaths. LVEF was significantly lower (median 37 v 44.5, p<0.001), WMIS higher (median 1.56 v 1.29, p<0.001) and NT-BNP higher (median 3.17 v 2.81, p<0.001) in those reaching end-point. Using a binary logistic regression, adjusting for confounding factors, both log WMIS (OR 99.97, p=0.036) and log NT-BNP (OR 2.25, p=0.012) were significant predictors of adverse outcome. LVEF was borderline significant (OR 0.969, p=0.087). In a Cox proportional hazard model both WMIS (HR 36.19, p=0.007) and NT-BNP (HR 1.66, p=0.023) remained independent predictors of end point. Kaplan–Meier curves revealed a significantly better outcome in patients with WMIS<median (diag). The receiver operator curves for WMIS yielded an area under curve (AUC) of 0.658, (95%CI 0.572–0.743, p<0.001) whereas for NT-BNP AUC was 0.666 (95%CI 0.580–0.751, p<0.001) and LVEF was 0.661 (95%CI 0.582–0.741, p<0.001). The logistic model combining all 3 markers yielded an AUC of 0.703 (95%CI 0.616–0.790, p<0.001.
Conclusion: After AMI echocardiographic measurements appear important predictors of outcome and may prove equivalent to NT-BNP.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||