Author/Authors :
Fontes-Oliveira, Marta Department Cardiology - University Hospital Center of Porto, Portugal , Martins, Filipe Abel Salazar Biomedical Sciences Institute - University of Porto, Portugal , Gomes, Luis Abel Salazar Biomedical Sciences Institute - University of Porto, Portugal , Trepa, Maria Department Cardiology - University Hospital Center of Porto, Portugal , Baggen-Santos, Raquel Department Cardiology - University Hospital Center of Porto, Portugal , Costa, Ricardo Department Cardiology - University Hospital Center of Porto, Portugal , Rodrigues, Patricia Department Cardiology - University Hospital Center of Porto, Portugal , Luz, Andre Department Cardiology - University Hospital Center of Porto, Portugal , Cabral, Sofia Department Cardiology - University Hospital Center of Porto, Portugal , Santos, Mario Department Cardiology - University Hospital Center of Porto, Portugal , Torres, Severo Department Cardiology - University Hospital Center of Porto, Portugal
Abstract :
Background: Patients with Acute Coronary Syndrome (ACS) with preserved Left
Ventricular Ejection Fraction (LVEF) have an incidence of adverse outcomes despite the
previously presumed benign prognosis.
Objective: We hypothesized that NT-pro-BNP could help refine the risk stratification of
these patients.
Methods: In this observational retrospective study, laboratory and clinical data were
collected from 232 consecutive patients with ACS and preserved LVEF (> 50%) and no
previous history of Heart Failure (HF) at hospital discharge. Associations between NTproBNP and the composite outcome of HF hospitalization, HF diagnosis de novo, and
all-cause mortality were assessed by univariate and multivariable Cox models. Statistical
analyses were performed using Stata software, version 12.1 and a two-sided P-value <
0.05 was considered to be statistically significant.
Results: The NT-proBNP median was 408 [IQR 177-853] pg/mL. Patients with increased
NT-proBNP were older and were more likely to be female (P = 0.013), be non-smoker (P =
0.039), have worse renal function (P < 0.001), and have lower hemoglobin concentration
(P < 0.001). They had more ST-Elevation Myocardial Infarction (STEMI) and evolved
with higher Killip classes (P < 0.001). Increased NT-proBNP levels were also associated
with higher peak values of Creatinine Kinase (CK) and troponin (r = 0.36, P < 0.001 and
r = 0.37, P < 0.001), higher left ventricular mass (P = 0.021), larger left atria (P = 0.013),
and higher prevalence of regional LV hypocontractility (P = 0.012 to P = 0.090). During
the 4.2 [2.1-5.4] years of follow-up, the composite outcome occurred in 19 patients.
After adjusting for age, sex, and Killip class, NT-proBNP was not associated with the
composite outcome (HR = 1.18; 95% CI: 0.78 - 1.78).
Conclusion: Post-ACS patients with preserved LVEF and increased levels of NT-proBNP
were older, had more comorbidities, and presented with a more severe myocardial
infarction. However, NT-proBNP levels measured during ACS hospitalization did not
predict the clinical adverse outcomes.
