B-Type Natriuretic Peptide and its Molecular Precursor in Myocardial Infarction Complicated by Cardiogenic Shock

• Published in: Journal of cardiac failure 2007-04, Vol.13 (3), p.184-188
• Main Authors: Hejmdal, Anders, MD, Boesgaard, Søren, MD, DMSc, Lindholm, Matias G., MD, Goetze, Jens Peter, MD, DMSc
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers - blood; BNP; Cardiogenic shock; Cardiovascular; Female; Humans; Male; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Natriuretic peptide; Natriuretic Peptide, Brain - blood; proBNP; Protein Precursors - blood; Shock, Cardiogenic - blood; Shock, Cardiogenic - complications; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - therapy
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2006.11.011

Abstract Background Plasma measurement of cardiac natriuretic peptides and their biosynthetic precursors is helpful in chronic heart failure patients. In contrast, information on circulating B-type natriuretic peptide (BNP) and its molecular precursor (proBNP) in patients with cardiogenic shock is scarce. We therefore examined proBNP-derived peptides in plasma from patients with myocardial infarction complicated by cardiogenic shock. Methods and Results Patients were referred for early, invasive therapy because of myocardial infarction complicated by cardiogenic shock (n = 13). Plasma proBNP was measured with an automated assay (NT-proBNP) and an in-house radioimmunoassay (proBNP); BNP concentrations were quantitated with an immunoradiometric assay. The median NT-proBNP concentration was 8.2-fold higher than the corresponding BNP concentration (873 pmol/L [range 41–12,486] versus 107 pmol/L [1–1041], P < .001). Moreover, the NT-proBNP concentration was 3.3-fold higher compared with proBNP (268 pmol/L [19–12,220], P < .01). Despite the molar differences, there was a strong correlation between NT-proBNP and proBNP ( r = 0.84, P < .0001) and BNP ( r = 0.82, P < .0001) concentrations. Gel filtration chromatography suggested that the proBNP immunoreactivity reflect a molecular form larger than the N-terminal 1-76 fragment. Conclusions The study reveals the plasma profile of proBNP-derived peptides during myocardial infarction complicated by cardiogenic shock. Peripheral concentrations of NT-proBNP, proBNP, and BNP were highly correlated despite marked differences between assays. The results also suggest an increase in cardiac proBNP processing after myocardial infarction and cardiogenic shock.