前壁急性心肌梗死后左心室逆向重构与B型利钠肽-cGMP级联反应之间的关联
Association between left ventricular reverse remodelling and the B-type natriuretic peptide-cGMP cascade after anterior acute myocardial infarction.
作者信息
Arai Marina, Asaumi Yasuhide, Honda Satoshi, Ogata Soshiro, Kiyoshige Eri, Nakao Kazuhiro, Miura Hiroyuki, Morita Yoshiaki, Nakashima Takahiro, Murai Kota, Iwai Takamasa, Sawada Kenichiro, Matama Hideo, Fujino Masashi, Takahama Hiroyuki, Yoneda Shuichi, Takagi Kensuke, Otsuka Fumiyuki, Kataoka Yu, Nishimura Kunihiro, Noguchi Teruo, Minamino Naoto, Yasuda Satoshi
机构信息
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
出版信息
Open Heart. 2025 Jan 11;12(1):e002927. doi: 10.1136/openhrt-2024-002927.
BACKGROUND
The role of cyclic guanosine 3',5'-monophosphate (cGMP) after acute myocardial infarction (AMI) is not well understood despite its significance as a second messenger of natriuretic peptides (NPs) in cardiovascular disease. We investigated the association between the NP-cGMP cascade and left ventricular reverse remodelling (LVRR) in anterior AMI.
METHODS
67 patients with their first anterior AMI (median age, 64 years; male, 76%) underwent prospective evaluation of plasma concentrations of the molecular forms of A-type and B-type natriuretic peptide (BNP) and cGMP from immediately after primary percutaneous coronary intervention (PPCI) to 10 months post-AMI. The estimated mature BNP (emBNP) concentration was calculated as the difference between total BNP and prohormone of BNP (proBNP) concentrations. Patients were divided into LVRR and non-LVRR groups on the basis of residuals between observed change in left ventricular end-systolic volume index on MR during the first 11 months after AMI and change adjusted for proBNP concentration immediately post-PPCI, which was calculated with regression. The LVRR group (n=33) had residuals below the median; the non-LVRR group (n=34) had residuals at or above the median.
RESULTS
The LVRR group had higher freedom from major adverse cardiac and cerebrovascular events (MACCEs) than the non-LVRR group during a median follow-up of 9.9 years (p=0.008). The presence of LVRR (HR 0.256; 95% CI 0.081 to 0.809; p=0.028) and peak creatine phosphokinase-myocardial band level (per 100 IU/L) (HR 1.22; 95% CI 1.02 to 1.46; p=0.027) were independent predictors of MACCE after adjusting for age, male sex, infarct size and hypertension. Multivariable analyses identified logarithmic proBNP and emBNP concentrations from 12 hours to 5 days post-AMI and logarithmic cGMP concentration from immediately post-PPCI to 3 days post-AMI as independent predictors of LVRR (p<0.05).
CONCLUSIONS
Early-phase BNP-cGMP cascade activation might play a crucial role in LVRR in anterior AMI.
背景
环磷酸鸟苷（cGMP）作为利钠肽（NPs）在心血管疾病中的第二信使，其在急性心肌梗死（AMI）后的作用尚未完全明确。我们研究了前壁AMI患者中NP - cGMP级联反应与左心室逆向重构（LVRR）之间的关联。
方法
67例首次发生前壁AMI的患者（中位年龄64岁；男性占76%），在直接经皮冠状动脉介入治疗（PPCI）后至AMI后10个月，前瞻性评估血浆中A型和B型利钠肽（BNP）的分子形式以及cGMP的浓度。估算的成熟BNP（emBNP）浓度通过总BNP浓度与BNP前体（proBNP）浓度之差计算得出。根据AMI后前11个月磁共振成像（MR）测量的左心室收缩末期容积指数的观察变化与PPCI后即刻根据proBNP浓度校正的变化之间的残差，将患者分为LVRR组和非LVRR组，残差通过回归计算。LVRR组（n = 33）的残差低于中位数；非LVRR组（n = 34）的残差等于或高于中位数。
结果
在中位随访9.9年期间，LVRR组发生主要不良心脑血管事件（MACCEs）的自由度高于非LVRR组（p = 0.008）。在校正年龄、性别、梗死面积和高血压后，LVRR的存在（HR 0.256；95% CI 0.081至0.809；p = 0.028）和肌酸磷酸激酶同工酶峰值水平（每100 IU/L）（HR 1.22；95% CI 1.02至1.46；p = 0.027）是MACCE的独立预测因素。多变量分析确定，AMI后12小时至5天的对数proBNP和emBNP浓度以及PPCI后即刻至AMI后3天的对数cGMP浓度是LVRR的独立预测因素（p < 0.05）。
结论
早期BNP - cGMP级联反应激活可能在前壁AMI的LVRR中起关键作用。
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