[Myocardial and Arterial Stiffness Important Determinant of NT-ProBNP at Development of Heart Failure in Survivors of Myocardial Infarction].

Aim: To study diagnostic value of myocardial-arterial stiffness (MAS) as a determinant of N-terminal pro-brain natriuretic peptide (NT-proBNP) expression in patients with chronic heart failure (CHF) with ischemic or postinfarction left ventricular (LV) dysfunction.
Material and Methods: We analyzed 6 months prognosis of 54 patients (mean age 61.7+/-8.6 years) with II-III NYHA class CHF divided into 2 groups: (I, n=18) with class II CHF and preserved LV ejection fraction (EF) (55+/-10.4%), (II, n=36) with class III CHF and low LF EF (30.4+/-6.8%). MAS was measured by echocardiography as ratio of arterial elasticity (Ea) and end-systolic elasticity of LV myocardium (Es). Serum NT-proBNP was measured by immunoenzyme assay.
Results: During 6 months follow-up one group II patient with initial NT-proBNP level 2020 rg/ml died. NT-proBNP level in group I was significantly lower than in group II (313 and 647 rg/ml, respectively). Ea/Es ratio was significantly higher (p=0.001) in group II. Multifactorial analysis demonstrated moderate correlation of NT-proBNP with Ea/Es ratio (r=0.50, p=0.0001) and negative correlation with LVEF (r=-0.45, =0.003) among patients with II-III class CHF.
Conclusion: As correlation between symptoms and severity of clinical manifestations of ischemic or postinfarction cardiac dysfunction at development of CHF was not high it appears rational to consider MAS estimated by Ea/Es ratio as independent predictor of cardiovascular complications. Sufficiently close correlation between NT-proBNP and Ea/Es ratio allows to improve stratification of risk and to assess objectively prognosis of the disease using easier obtainable parameter Ea/Es in cases when possibility to measure NT-proBNP is not available.