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Plasma levels of vasoactive propeptides (proANP and BigET-1)in patients with acute myocardial infarction treated by percutaneous coronary intervention

Cardiovascular stress and ischemic-reperfusion events are important stimuli to disarrangement of balanced two opposite systems which participate in the blood pressure and sodium homeostasis. The plasma levels of big endothelin-1 (vasoconstrictor) and proatrial natriuretic peptide (vasodilatator), the most stabile biological precursor of active peptides ANP and ET-1 was investigated during PCI and 6 hours after. 29 patients (33-80 yrs ; median=62) within 2 hours of pain onset addmitted in Coronary Care Unit for PCI and their EDTA blood samples from periferal vein were taken before and 6 hours after PCI and have determinated by enzymimmunoassay, Biomedica, Wien. Mann-Whitney and Pearson correlation tests were used for statistical evaluation. The medians of BigET-1 and proANP (fmol/ml) in all groups of samples were elevated according to reference values except values of 6V proANP: 0A=3, 20 ; 0V=3, 0 ; 6V=3, 7 and 0A=1925, 5 ; 0V=2986, 0 ; 6V=1244, 5, respectively. ProANP values of all tree groups of samples were statistically different among each other (P=0, 011). However, BigET-1 measurements are coherent between groups. Weak positive correlation was observed between plasma values of 6VproANP and ages (r=0, 52 ; P=0, 0049). Strong positive relations were found for all pairs of proANP - 0A:0V (r=0, 840 ; P<0, 001), 0A:6V (r=0, 590 ; P<0, 001), 0V:6V (r=0, 664 ; P<0, 001). Weaker, but significant correlation was showed for pairs of BigET-1- 0A:0V (r=0, 521 ; P=0, 003), 0A:6V (r=0, 490 ; P=0, 007), 0V:6V (r=0, 536 ; P=0, 003). There is no significant correlation between proANP and BigET- 1. Specific local coronary artery event and vasodilatation ahed of occlusionin comparison with perifer higer levels, and diminsh of systemic ANP secretion 6 hours after reperfusion. BigET-1 remain elevated due to numerous stimulations: growth factors, angiotensin system, catecholamins, oxLDL, trombin, reduced cardiac output etc. Furthermore, the vasoconstriction properties of ET-1 are greatly hightened in atherosclerotic vessels in which the biologic effect of NO stimuli to ANP secretion is lost. According to literature data levels three days after AMI have the major prognostic value. Conclusion: The plasma levels of proANP and BigET-1 correlate well with severity of disease, the levels changes are obvious, so the measurement of circulation concentrations may be useful as a prognostic index. This preliminary resultes suggest the predictive value of proANP for monitoring of PCI efficiency. The future investigations will be to follow-up one-year mortality rate, appearance of cardiovascular events, correlation with clinical and haemodinamic features to evaluate the prognostic index of measurement vasoactive peptides after AMI.

proANP; BigET-1; cardiovascular stress; ischemic-reperfusion events

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