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Heart failure and cardiomyopathies
Original research
B-type natriuretic peptide and cardiac remodelling after myocardial infarction: a randomised trial
  1. Scott A Hubers1,
  2. John A Schirger1,
  3. S Jeson Sangaralingham1,2,
  4. Yang Chen1,2,
  5. John C Burnett Jr1,2,
  6. David Hodge3,
  7. Horng H Chen1,2
  1. 1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Cardiorenal Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Scott A Hubers, Cardiovascular Medicine, Mayo Clinic, Rochester, MI 55905-0002, USA; hubers.scott{at}mayo.edu

Abstract

Objective B-type natriuretic peptide (BNP) has favourable effects on left ventricular remodelling, including antifibrotic and antiapoptotic properties. We tested the hypothesis that infusion of BNP after an acute myocardial infarction would reduce left ventricular systolic and diastolic volumes and improve left ventricular ejection fraction compared with placebo.

Methods A total of 58 patients who underwent successful revascularisation for an acute ST elevation anterior myocardial infarction were randomised to receive 72-hour infusion of BNP at 0.006 µg/kg/min or placebo. Left ventricular end diastolic and systolic volumes and left ventricular ejection fraction were measured at baseline and at 30 days by multigated acquisition scan. Left ventricular infarction size was measured by cardiac MRI.

Results BNP infusion led to significantly higher BNP levels and plasma cyclic guanosine monophosphate at 72 hours. No significant difference in change of left ventricular volumes or ejection fraction from baseline to 30 days was observed between groups. Although left ventricular infarction size measured by cardiac MRI was not significantly different between BNP infusion versus placebo (p=0.39), there was a trend towards reduced infarction size in patients with a baseline ejection fraction of <40% (p=0.14).

Conclusions Infusion of BNP in patients with an anterior myocardial infarction did not affect parameters of left ventricular remodelling. Patients treated with BNP who had a baseline left ventricular ejection fraction of <40% had a trend towards reduced left ventricular infarction size compared with placebo. These results do not support the use of intravenous BNP in patients after recent myocardial infarction.

Trial registration number NCT00573144.

  • acute myocardial infarction
  • heart failure with reduced ejection fraction

https://doi.org/10.1136/heartjnl-2020-317182

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    Footnotes

    • Twitter @scott_hubers

    • Contributors All authors have read and approved this manuscript. SH contributed to data analysis and initial manuscript draft. JAS, SJS and YC contributed to data analysis. JCB contributed to the concept, design and data analysis of the study. DH provided data analysis and statistical support. HHC contributed to the concept, design, patient recruitment, data analysis and final approval of the manuscript.

    • Funding This work was supported by the National Institutes of Health (P20 HL101439 and R01 HL832310).

    • Competing interests JCB and HHC have patented designer natriuretic peptides. JCB and HHC are also the co-founders of Zumbro Discovery.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by Mayo Clinic’s Institutional Review Board and was conducted according to the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.