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Letter to the Editor B-type natriuretic peptide for the prediction of left ventricular remodelling Dear Sir We read with great interest the recent article by Choi et al.1 on the optimal time of B-type natriuretic peptide (BNP) sampling for the prediction of left ventricular (LV) remodelling after myocardial infarction (MI). Indeed, as underscored by Choi et al., LV remodelling remains a significant clinical problem in the modern era of MI management.2 In addition, BNP is currently the sole biomarker that has been convincingly associated with LV remodelling in multiple studies (reviewed in Fertin et al.3). It is therefore important to determine the best window of time for its determination in clinical practice. Using multivariate analysis in a cohort of 131 patients, the authors found that early levels (two to five days) of BNP were associated with LV remodelling in fully adjusted models, whereas late (three to four weeks) and long-term (six months) levels were not. We previously reported on the usefulness of serial (three to seven days, one, three and 12 months) assessment of BNP to predict LV remodelling after MI in a prospective study of 246 patients with a first anterior Q-wave MI.4 Our results, which were at variance from those of the study by Choi et al., demonstrated that BNP levels at any time point were associated with LV remodelling; the association was mild at baseline and stronger during follow up, particularly after three months. With multivariate analysis, BNP retained its predictive value at one, three and 12 months, but no longer at baseline. These
discrepancies between studies may be related to differences in study populations and/or therapeutic management. It is also important to know how missing values were handled when comparing models at different time points. From the data presented by Choi et al., it appears that BNP measurements at six months were lacking in more than 20% of the cases. This could theoretically have ‘disadvantaged’ BNP in late versus early models. At present, we believe that the optimal timing after MI for BNP determination in clinical practice remains an unsettled question. Christophe Bauters, MD,
[email protected] Centre Hospitalier Régional et Universitaire de Lille, Lille; Inserm U744, Institut Pasteur de Lille, Université de Lille 2, Lille; Faculté de Médecine de Lille, Lille, France Marie Fertin, MD Florence Pinet, PhD Centre Hospitalier Régional et Universitaire de Lille, Lille; Inserm U744, Institut Pasteur de Lille, Université de Lille 2, Lille continued on page 39…
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branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463. Pozzoli M, Capomolla S, Pinna G, Cobelli F, Tavazzi L. Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation. J Am Coll Cardiol 1996; 27: 883–893. Rossi A, Cicoira M, Golia G, Anselmi M, Zardini P. Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: the advantage of enddiastolic markers. J Am Soc Echocardiogr 2001; 14: 562–568. Temporelli PL, Scapellato F, Corra U, Eleuteri E, Imparato A, Giannuzzi P. Estimation of pulmonary wedge pressure by transmitral Doppler in patients with chronic heart failure and atrial fibrillation. Am J Cardiol 1999; 83: 724–727. Diwan A, McCulloch M, Lawrie GM, Reardon MJ, Nagueh SF. Doppler estimation of left ventricular filling pressures in patients with mitral valve disease. Circulation 2005; 111: 3281–3289. Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a
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tion in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group). Am J Cardiol 2006; 98: 1144–1149 (17056315). Fertin M, Dubois E, Belliard A, Amouyel P, Pinet F, Bauters C. Usefulness of circulating biomarkers for the prediction of left ventricular remodeling after myocardial infarction. Am J Cardiol 2012; 110: 277–283 (22482862). Fertin M, Hennache B, Hamon M, Ennezat PV, Biausque F, Elkohen M, et al. Usefulness of serial assessment of B-type natriuretic peptide, troponin I, and C-reactive protein to predict left ventricular remodeling after acute myocardial infarction (from the REVE-2 study). Am J Cardiol 2010; 106: 1410–1416 (21059429).
