Significance of the N-terminal Fragment of Brain Natriuretic Peptides in Predicting Ventricular Arrhythmias in Young and Middle-Aged Patients with Diabetes and Myocardial Infarction

Abstract

Fatal ventricular arrhythmias in patients with diabetes mellitus (DM) in the acute stage of myocardial infarction (MI) and postinfarction period often cause adverse outcomes. Therefore, the search for new reliable biomarkers in predicting ventricular arrhythmias in the long term is necessary.

AIM: This study aimed to evaluate the value of N-terminal-pro hormone BNP (NT-proBNP) in predicting ventricular arrhythmias in young and middle-aged patients with MI and DM-associated ST-segment elevation.

MATERIALS AND METHODS: Seventy-six patients (59 men and 17 women) with DM and MI with ST-segment elevation (aged 36–59 years; mean 53 ± 5 years) were examined. Anterior MI was diagnosed in 35 patients, and non-anterior MI was detected in 41 patients. The DM duration was up to 1 year in 16 patients, 1–5 years in 24, and 5–12 years in 36. Patients were examined on day 1 after percutaneous coronary intervention (PCI) with implantation of 1–3 stents in the coronary arteries (CA) and again after 12 months. Holter monitoring, echocardiography, and blood tests for NT-proBNP were performed.

RESULTS: After PCI, ventricular extrasystole (VES) of grades III–V according to Lown and Wolf was detected in 21 of 37 (56.7%) patients with DM. The left ventricular ejection fraction (LVEF) was 42% (27%–45%), and the NT-proBNP level was 1127 (790–2530) at a rate of up to 125 pg/mL. After 12 months, VES was noted in 9 of 37 (24.3%) patients. The LVEF was 33% (28%–35%), and the NT-proBNP level was 938 (497–1294) pg/mL. A positive correlation was found between the blood serum level of NT-proBNP on day 1 after PCI and the number of grade III–V VES 12 months later. At an NT-proBNP level of > 898 pg/mL on day 1 after PCI, the sensitivity of this biomarker in predicting high-grade VES 12 months after MI in patients with DM was 100%.

CONCLUSIONS: The NT-proBNP level after PCI in patients with DM and MI is a reliable predictor of ventricular arrhythmias over the next 12 months.

Keywords

myocardial infarction / diabetes mellitus / percutaneous coronary intervention / N-terminal fragment of brain natriuretic peptide / ventricular extrasystole

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