BNP infusion after MI fails to lower LV volume or improve ejection fraction
In a randomized controlled trial, post-MI B-type natriuretic peptide infusion failed to reduce left ventricular volume or improve LV ejection fraction compared with placebo, researchers reported.
According to findings published in Heart, LV infarction size measured by cardiac MRI was also not significantly different between B-type natriuretic peptide (BNP) infusion compared with placebo, but investigators did observe a trend toward reduced infarction size among patients with baseline LVEF less than 40% (P = .14).
“We could not demonstrate that acute infusion of nesiritide in patients with a recent anterior acute MI had favorable effects on parameters of left ventricular remodeling, including LV end diastolic volume index, LV end systolic volume index and LVEF,” Scott A. Hubers, MD, cardiovascular disease cardiology specialist in the department of cardiovascular medicine at Mayo Clinic in Rochester, Minnesota, and colleagues wrote.
For this study, investigators enrolled 58 patients with acute STEMI who underwent successful revascularization and randomly assigned them to 72-hour BNP infusion (0.006 g/kg per minute) or placebo. Measurements of LV end diastolic and systolic volumes and LVEF were taken at baseline and at 30 days.
Researchers observed no significant difference between BNP infusion and placebo for:
- LV end diastolic volume (LVEF < 40%, P = .24; LVEF 40%, P = .18);
- LV end systolic volume (LVEF < 40%, P = .1; LVEF 40%, P = .33);
- change in LVEF (LVEF < 40%, P = .36; LVEF 40%, P = .67); and
- infarction size (LVEF < 40%, P = .14).
“Although we did not detect a benefit of acute administration of B-type natriuretic peptide in our study, large randomized clinical trials, such as the PARADISE- MI trial, are investigating whether blocking degradation of natriuretic peptides chronically with angiotensin receptor-neprilysin inhibition is beneficial in the post-myocardial infarction population,” the researchers wrote.