Abstract
Atrial natriuretic peptide (ANP) is secreted in response to the stretching of the atrial wall. Atrial ischemia most likely impairs the ability of atrial myocytes to produce ANP. Atrial infarction (AI) is rarely diagnosed but not infrequently associated with myocardial infarction (MI). The aim of the study was to assess the association between AI and the prognostic value of N-terminal proANP (NT-proANP) in patients with MI treated with primary percutaneous coronary intervention (PCI). We evaluated data of 100 consecutive patients. Plasma levels of NT-proANP were measured by the ELISA method. ECG recordings were interpreted to diagnose AI according to Liu’s criteria. All patients were followed-up prospectively for 12 months for the manifestation of major adverse cardiovascular events (MACE), defined as unplanned coronary revascularization, stroke, reinfarction or all-cause death. AI was diagnosed in 36 patients. 14% of patients developed MACE. AI did not affect the incidence of MACE or any of its components, nor the patients’ prognosis. NT-proANP revealed to be a strong predictor of death but was not associated with other adverse events. Conclusions: AI in patients with MI treated with primary PCI is not connected with their prognosis nor affects the usefulness of NT-proANP in predicting death during the 12-month follow-up.
Highlights
There are two natriuretic peptides, structurally similar but genetically distinct, that are produced and secreted mainly by the chambers of the heart: atrial natriuretic peptide (ANP) secreted from the atria and B-type natriuretic peptide (BNP) secreted from the ventricles [1,2]
We found that right atrial infarction (RAI) diagnosis was not associated with NT-proANP concentrations, both on admission to hospital and on the 4th day of hospitalization (p = 0.4350; p = 0.5046, respectively, Figure 2a,b)
In our prospective study among patients with segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) of right coronary artery (RCA) as infarct-related artery (IRA), we diagnosed RAI in 36% of patients
Summary
There are two natriuretic peptides, structurally similar but genetically distinct, that are produced and secreted mainly by the chambers of the heart: atrial natriuretic peptide (ANP) secreted from the atria and B-type natriuretic peptide (BNP) secreted from the ventricles [1,2]. ANP, like all natriuretic peptides, is synthesized as a preprohormone. The first 25 amino acids comprise a signal sequence, and the following 126 amino acid peptides constitute proANP, which is the major form of ANP stored in secretory atrial granules. When released from these granules, proANP is immediately split by corin and forms a biologically active 28 amino acid peptide–ANP and inactive N-terminal proANP (NT-proANP). The active ANP is decomposed by the action of neutral endopeptidase and by binding to the natriuretic peptide receptors.
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