Int J Med Sci 2017; 14(1):75-85. doi:10.7150/ijms.17145 This issue

Research Paper

Predictors of Left Ventricle Remodeling: Combined Plasma B-type Natriuretic Peptide Decreasing Ratio and Peak Creatine Kinase-MB

Jen-Te Hsu1, Chang-Min Chung1, Chi-Ming Chu2, Yu-Shen Lin1, Kuo-Li Pan1, Jung-Jung Chang1, Po-Chang Wang1, Shih-Tai Chang1, Teng-Yao Yang1, Shih-Jung Jang3, Tsung-Han Yang4, Ju-Feng Hsiao1✉

1. The Department of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
2. Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taiwan.
3. The Department of Cardiology, Taipei Tzu Chi General Hospital, Taiwan.
4. Department of Laboratory Medicine, Chang-Gung Medical Foundation.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
Hsu JT, Chung CM, Chu CM, Lin YS, Pan KL, Chang JJ, Wang PC, Chang ST, Yang TY, Jang SJ, Yang TH, Hsiao JF. Predictors of Left Ventricle Remodeling: Combined Plasma B-type Natriuretic Peptide Decreasing Ratio and Peak Creatine Kinase-MB. Int J Med Sci 2017; 14(1):75-85. doi:10.7150/ijms.17145. Available from

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Background: Previous studies reported that patients who had an acute myocardial infarction (AMI) have found that measuring B-type natriuretic peptide (BNP) during the subacute phase of left ventricular (LV) remodeling can predict the possible course of LV remodeling. This study assessed the use of serial BNP serum levels combined with early creatine kinase-MB (CK-MB) to predict the development of significant LV remodeling in AMI patients.

Methods: Nighty-seven patients with new onset AMI were assessed using serial echocardiographic studies and serial measurements of BNP levels, both performed on day-2 (BNP1), day-7 (BNP2), day-90 (BNP3), and day-180 (BNP4) after admission. LV remodeling was defined as >20% increase in biplane LV end-diastolic volume on day-180 compared to baseline (day-2).

Results: Patients were divided into LV remodeling [LVR(+)] and non LV remodeling [LVR(-)] groups. No first-week BNP level was found to predict remodeling. However, the two groups had significantly different day-90 BNP level (208.1 ± 263.7 pg/ml vs. 82.4 ± 153.7 pg/ml, P = 0.039) and significantly different 3-month BNP decrease ratios (RBNP13) (14.4 ± 92.2% vs. 69.4 ± 25.9%, P < 0.001). The appropriate cut-off value for RBNP13 was 53.2% (AUC = 0.764, P < 0.001). Early peak CK-MB (cut-off 48.2 ng/ml; AUC = 0.672; P = 0.014) was another independent predictor of remodeling. Additionally, combining peak CK-MB and RBNP13 offered an excellent discrimination for half-year remodeling when assessed by ROC curve (AUC = 0.818, P < 0.001).

Conclusion: RBNP13 is a significant independent predictor of 6-month LV remodeling. The early peak CK-MB additionally offered an incremental power to the predictions derived from serial BNP examinations.

Keywords: B-type Natriuretic Peptide (BNP), left ventricular remodeling, acute myocardial infarction (AMI), BNP decrease ratio, peak creatine kinase-MB.