Reference Values and Release Kinetics of B-Type Natriuretic Peptide Signal Peptide in Patients with Acute Myocardial Infarction.

Abstract

BACKGROUND:

The signal peptide for human B-type natriuretic peptide preprohormone (BNPsp), which is released from cardiomyocytes, is increased in plasma of patients with acute myocardial infarction (AMI); however, its exact release kinetics have not been defined.

METHODS:

We measured BNPsp and high-sensitivity cardiac troponin T (hs-cTnT) in a reference group of individuals without structural heart disease (n = 285) and determined the release kinetics of these biomarkers in patients (n = 29) with hypertrophic obstructive cardiomyopathy undergoing transcoronary ablation of septal hypertrophy (TASH), a procedure allowing exact timing of onset of iatrogenic AMI. Blood samples were collected before TASH and at numerous preselected time points after TASH.

RESULTS:

The reference median BNPsp concentration was 53.4 pmol/L [interquartile range (IQR) 47.0-61.0; 95th percentile 85.9 pmol/L; 99th percentile 116.3 pmol/L]. Baseline concentrations in patients undergoing TASH were higher than in the reference group [91.9 pmol/L (IQR 62.9-116.4); P < 0.0001]. BNPsp increased significantly, peaking at 15 min after induction of AMI [149.6 pmol/L (109.5-204.9) vs baseline; P = 0.004] and declining slowly thereafter, falling below the preprocedural value after 8 h (P = 0.014). hs-cTnT increased significantly 15 min after induction of AMI [26 ng/L (19-39) vs 18 ng/L (11-29); P = 0.001] and remained high at all later time points.

CONCLUSIONS:

BNPsp concentrations increased immediately after AMI induction, providing early evidence of myocardial injury. The release kinetics of BNPsp differed from those of hs-cTnT. These findings provide information that should help in establishing the diagnostic value of BNPsp in the setting of early AMI.

• Authors: Christoph Liebetrau, Luise Gaede, Oliver Dörr, Johannes Blumenstein, Stefanie Rosenburg, Jedrzej Hoffmann, Christian Troidl, Christian W Hamm, Holger M Nef, Helge Möllmann, A Mark Richards, Chris J Pemberton
• Journal: Clinical chemistry (Clin Chem) Vol. 61 Issue 12 Pg. 1532-9 (Dec 2015) ISSN: 1530-8561 [Electronic] England
• PMID: 26506995 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Association for Clinical Chemistry.

Chemical References

• Biomarkers
• Protein Sorting Signals
• Troponin T
• Natriuretic Peptide, Brain

Topics

• Ablation Techniques
• Aged
• Biomarkers (blood)
• Cardiomyopathy, Hypertrophic (blood, pathology, surgery)
• Case-Control Studies
• Early Diagnosis
• Female
• Heart Septum (metabolism, pathology, surgery)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnosis, pathology, surgery)
• Myocytes, Cardiac (metabolism, pathology)
• Natriuretic Peptide, Brain (blood)
• Prognosis
• Protein Sorting Signals
• Reference Values
• Troponin T (blood)