PREDICTION OF MYOCARDIAL VIABILITY ON THE BASIS OF SERUMBNP AND HSTROPONIN I LEVELS IN PATIENTS WITH CORONARYARTERY DISEASEWITH LVSYSTOLIC DYSFUNCTION

Introduction: Coronary artery disease (CAD) is the leading cause of heart failure (HF). Only viable dysfunctional myocardium (hibernation) is potentially recoverable with restoration of adequate perfusion. Cardiac imaging modalities have emerged with the ability to differentiate between myocardial scar and viable myocardium and are now often used to direct therapy decisions including revascularization. Decrease in wall motion score (WMS) and improvement in LV ejection fraction (LVEF) during DSE is considered as a surrogate marker for viability of myocardium. It is largely unknown how cardiac specific biomarkers are released in relation the presence and extent of hibernation in patients with ischemic HF. The objectives of this study are to assess the relationship and interaction of the biomarkers BNP and hs TnI with hibernation in patients with chronic ischemic HF. Materials and methods: It is a single center observational study which is conducted in Department of Cardiology, S.M.S. Medical College, Jaipur. 70 eligible patients with suspected ischemic cardiomyopathy (ICMP) are prospectively recruited into an imaging study using DSE to determine viability of myocardium. The patients also had blood sampling at baseline to determine biomarkers. Results: Mean age (in yrs) of patients is 63.78 ± 10.69 years. No patient is in NYHA I. 25.7 % of patients are in NYHA II (18 patients); 36 patients (51.4%) are in NYHA III and 16 patients (22.8%) are in NYHA IV. On comparison of baseline characteristics among patients with different NYHA class, there is a progressive increase in level of cardiac biomarkers with increase in NYHA class. Both BNP and hs TnI levels are significantly elevated in patients with Improvement in EF >10% as compared with Improvement in EF <10% There is a continuous relationship between increasing degrees of hibernation and increasing BNP and hs Trop I levels. HsTrop I had predicted a positive 56.6% change in Improvement in LVEF. HsTrop I had predicted a positive 52.5% change in decrease in WMS. Conclusion: The current study support the novel concept that the extent of LV hibernation are determinant of serum BNP and hs Trop I elevation in patients with ischemic HF and hs Trop I levels in patients with ischemic HF relate to the degree of hibernation.