Abstract
Left ventricular remodeling (LVR) is one of the complications of myocardial infarction, leading to heart failure. The objective of this study is to clinical, echocardiographic and natriuretic peptides metabolism parameters associated with LVR. This prospective, multicentric study includes patients with first myocardial infarction and at least 3 akinetic segments at the initial echocardiography. LVR is defined as an increase of left ventricular end-diastolic volume (LVEDV) of 20% at 6 months. Neprilysin concentration and activity, NT-proBNP, MR-proANP and galectine 3 were measured the fourth day after the event (D4) and six months later (M6). Three hundred and seven patients are included. One hundred and thirty-three patients (43%) display LVR at 6 months. Factors associated to LVR in multivariate analysis are WMSI score, initial LVEDV and LDL cholestérol. At D4, neprilysin concentration is of 298 pg/mL [239–355], neprilysin activity of 0.28 nM/mL/min [0.14–0.38], galectin 3 concentration of 18.7 ng/mL [15.6–23.4], NT- proBNP of 1770 ng/L [724–5468] and MR-proANP concentration of 501 pmol/L [272–951]. At D4, NT-proBNP is the only biological parameter associated with LVR (2154 ng/L [878–6078] versus 1602 ng/L [610–4815], P = 0.03). Nevertheless, none of natriuretic peptides metabolism parameters is an efficient predictor of LVR ( Fig. 1 ). At M6, neprilysin concentration is of 172 pg/mL [125–219], neprilysin activity of 0.19 nM/mL/min [0.16–0.27], NT-proBNP of 1323 ng/L [542–2721] and MR-proANP concentration of 487 pmol/L [247–855]. Neprilysin concentration, neprilysin activity and NT-proBNP are significantly decreased at M6 ( P < 0.001). Nevertheless, none of the parameters measured at M6 are associated with LVR. LVR is still frequent after myocardial infarction, related to infarct size and previous left ventricular morphology. Biological markers of natriuretic peptides metabolism are slightly changed after myocardial infarction without association with LVR.
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