Relationship between levels of Copeptin, NTproBNP and structural functional parameters of the heart in patients with acute myocardial infarction with ST-segment elevation complicated by pulmonary hypertension

Abstract

Introduction: Acute Myocardial Infarction with ST-Segment Elevation (STEMI) - one of the major causes of morbidity and mortality worldwide, including in Ukraine. The prevalence of pulmonary hypertension (PH) in STEMI significantly is not known due to lack of epidemiological studies in this area. Currently, the prognostic significance of PH in patients with STEMI is not set.

Objective: To evaluate the levels of NTproBNP and Copeptin and their relationship with structural and functional features of the heart in patients with STEMI complicated by PH.

Materials and Methods: The study involved 85 patients (49 men and 36 women) with STEMI who were treated in intensive care and emergency cardiology for the treatment of patients with myocardial infarction communal non-profit enterprise "City hospital and emergency ambulance" Zaporizhia city council. Patients were divided into two groups: 53 patients with STEMI in the presence of PH (mean age 72,40 ± 2,26 years), 32 patients with STEMI without PH (mean age 67,30 ± 2,12 years).

Results: In assessing the clinical anamnesis (Table 1) found that PH mainly develops in the anterior localization of  STEMI (73,6%). In patients with STEMI in the presence of PH compared with patients without significant PH frequently observed violations systolic function (64,2%). Significant increasing in the level of  copeptin (p <0,05) were found in the serum of patients with acute myocardial infarction in the presence of PH compared with patients with normal pressure in the pulmonary artery (PA). NTproBNP level was also higher in patients with STEMI and PH compared with patients without PH. In patients with STEMI and PH we found reliable positive correlation between the NTproBNP and copeptin level (+0,31; p <0,05), systolic pressure in PA (0,41; p <0,05) and negative correlation between NTproBNP level and ejection fraction (-0,41; p <0,05), stroke volume (-0,42; p <0,05). Copeptin positively correlated with the level of NTproBNP (+0,31; p <0,05), systolic pressure in PA (0,37; p <0,05) and negatively correlated with ejection fraction (-0,30; p <0,05 ).

Conclusions: Pulmonary hypertension develops mainly in the anterior localization of STEMI (73,6%) in the presence of systolic dysfunction (64,2%). In patients with STEMI and PH level of NTproBNP and copeptin in serum were increased compared than patients without PH. In patients with STEMI and PH NTproBNP and copeptin levels correlated with decreased left ventricular ejection fraction and increased pressure in the pulmonary artery.