Evaluation of Neurohumoral Activation (Adrenomedullin, BNP, Catecholamines, etc.) in Patients with Acute Myocardial Infarction
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概要
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Objective The object of our study was to identify the most useful predictor of patient prognosis in acute myocardial infarction (AMI), from 7 acute-phase cardiovascular peptides which take part in neurohumoral activation [brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, adrenomedullin, epinephrine and norepinephrine]. Methods In 141 consecutive AMI patients, 24 hours from onset, we evaluated plasma concentration levels of the 7 types of cardiovascular peptides and the relationships between the values of these peptides and short-term clinical prognosis, including mortality. Results Plasma levels of all cardiovascular peptides were significantly higher in patients who suffered mortality than in surviving patients (BNP: 1, 267±997 pg/ml vs. 293±327 pg/ml, p<0.0001; ANP: 164±186 pg/ml vs. 64±76 pg/ml, p<0.001; adrenomedullin: 13.61±3.29 Fmol/l vs. 3.45±1.52 Fmol/l, p<0.0001; renin: 8.79±7.15 ng/ml/h vs. 4.34±5.10 ng/ml/h, p<0.01; aldosterone: 249±210 pg/ml vs. 68±74 pg/ml, p<0.0001; epinephrine: 3, 191±8, 360 pg/ml vs. 68±74 pg/ml, p<0.0001; norepinephrine: 21.8±46.2 ng/ml vs. 0.9±0.8, ng/ml p<0.0001). Multivariate analysis identified only high levels of adrenomedullin as an independent related factor of cardiogenic shock (risk ratio: 5.84, 95% C.I.: 1.80-18.95, p=0.003), and as an independent predictor of short-term mortality (risk ratio: 16.16, 95% C.I.: 1.38-189.71, p=0.03). Conclusions Acute-phase neurohumoral activation, involving renin, aldosterone, epinephrine, norepinephrine, BNP, ANP, and adrenomedullin may be closely related to poor patient outcomes, including mortality. Our results suggest that acute-phase plasma adrenomedullin concentrations may be the most useful predictor of patient prognosis in the setting of AMI, out of the 7 types of cardiovascular peptides involved in neurohumoral activation.
- 社団法人 日本内科学会の論文
- 2004-11-01
著者
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Nakashima Hiroshi
Department Of Cardiology Nagasaki Citizens Hospital
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Suzuki Shin
Department of Cardiology, Sakakibara Heart Institute
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Katayama Toshiro
Department of Cardiology, Nagasaki Kouseikai Hospital
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Katayama Toshiro
Department Of Cardiology Kouseikai Hospital
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Yano Katsusuke
Department of Cardiovascular Medicine and Course of Medical and Dental Science, Graduate School of B
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Honda Yukiharu
Department of Cardiology, Nagasaki Citizens Hospital
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Yano Katsusuke
Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome
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Honda Yukiharu
Department Of Cardiology Nagasaki Citizens Hospital
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Suzuki Shin
Department Of Cardiology Nagasaki Citizens Hospital
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Yano Katsusuke
Department Of Cardiology Nagasaki University Hospital
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FURUDONO Shinnosuke
Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Bio
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Yano Katsusuke
Department Of Cardiovascular Medicine Course Of Medical And Dental Sciences Graduate School Of Biome
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Nakashima Hiroshi
Department Of Biology Faculty Of Science Okayama University
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Furudono Shinnosuke
Department Of Cardiology Nagasaki Citizens Hospital
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