The Correlation Study Between Plasma N-Terminal Pro-B-Type Natriuretic Peptide And Acute Coronary Syndrome

Object: This study addressed to measure plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration in patients with acute coronary syndrome, stable angina pectoris and normal healthy subjects, and aims to investigate the corroleation of between NT-proBNP and acute coronary syndrome, and the clinical significance.Methods: one hundred and ninety subjects were divided into three groups: 120 patients with acute coronary syndrome: include 40 patients with ST-segment elevation-acute myocardial infarction, 40 patients with non-ST-segment elevation -acute myocardial infarction, 40 patients with unstable angina; 40 patients with stable angina, and 30 normal healthy subjects who were matched with age and sex as control. Plasma NT-proBNP concentration was determined by enzyme linked immunoasorbent assay method and echocardiography was perfomed in all patients with coronary artery disease to detect left ventricular ejection fraction (LEVF), left ventricular volume parameters and to evaluate ventricular wall-motion, all subjects have undergone coronary artery angiography, the presence and degree of coronary stenoses was assayed by visual estimation. All data was analyzed with SPSS 10.0 statistical software; Numerical data was reported as the median value ± standard deviation; Significant test uses t test;Correlation test uses multi-variate/stepwise regression analysis; Unordered categorical viariables uses chi-square test, probability value was considered significant when <0.05. Results:1. Plasma NT-proBNP concentration was increased in patients with acutecoronary syndrome[ (257.6±148.3) pmol/L]compared with those of stableangina [ (135.7±31.8) pmol/L] and control subjects [ (132.8±35.9) pmol/L],P<0.05, respectively. However, there was no significant difference between the patients with stable angina and control subjects, P>0.05.2. LVEF was decreased, left ventricular end diastolic volume (LVEDV), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume (LVESV), left ventricular end systolic volume index (LVESVI) were higher in patients acute coronary syndrome compared with those of stable angina and normal contral, P<0.05.3. After multi-variate regression analysis, plasma NT-proBNP concentration was negative correlated with LVEF in patients with acute coronary syndrome, r=-0.58, P<0.001, were positive correlated with LVEDV, LVEDVI, LVESV, LVESVI (r=0.41, 0.43, 0.54, 0.57, P<0.001), plasma NT-proBNP concentration was correlated with Killip classification, and increased significantly in patients with abnormal LVEF (LVEF<50%) compared with patients with normal LVEF(LVEF>50%), P<0.05. Even though LVEF was normal in patients with acute coronary syndrome, plasma NT-proBNP concentration was still higher than patients with stable angina, P<0.05.4. Located ventricular wall-motion was higher in patients with acute coronary syndrome compared with those of stable angina, x ~2=356.60, P<0.005. In patients with acute coronary syndrome, LVEF of patients with located ventricular wall-motion abnormal was decreased significantly compared withthose of patients with normal ventricular wall-motion [ (0.49±0.09) vs(0.72±0.11)], P<0.005, plasma NT-proBNP concentration was no significant difference in two groups[(259.4±149.3)pmol/Lvs(254.6±150.4)pmol/L],5. Among patients ACS, plasma NT-proBNP concentrations in patients with three-vessel [(368.6±247.9)pmol/L] was higher than those of patients withtwo-vessel[ (317.8±218.3)pmol/L]and single vessle[(215.1±126.5)pmol/L],P<0.05, P<0.01.plasma NT-proBNP concentrations in patients with left anterior descendingcoronary artery (LAD) [(306.8±203.6)pmol/L]was higher than those of patients with right coronary artery (RCA) [(197.4±99.5)pmol/L] and left circumflexcoronary artery (LCX) [ (189.5± 101.7) pmol/L], P 均<0.01.Conclusion:Plasma NT-proBNP concentration was increased significantly in patients with acute coronary syndrome, and the result suggested that NT-proBNP might be a useful risk marker for patients with acute coronary syndrome; moreover, the concentration of plasma NT-proBNP was negative correlated with abnormal LVEF, was correlated with Killip classification; plasma NT-proBNP concentration was correlated with left ventricular volume parameters, and the result suggested that NT-proBNP might be a recently predictive marker of left ventricular remodeling for patients with acute coronary syndrome; To patients with acute coronary syndrome, elevated NT-proBNP levels are associated with tighter culprit vessel stenosis, and LAD involvement, may be associated with a greater severity and territory of myocardial ischemia. The result may partly explain at least the association between elevated NT-proBNP and adverse outcomes.