Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter November 18, 2021

Role of N-terminal pro-B-type natriuretic peptide and troponin T in predicting right ventricular recovery in myocardial infarction

  • Mustafa Umut Somuncu EMAIL logo , Fatih Pasa Tatar , Belma Kalayci , Ahmet Avci , Naile Eris Gudul , Nail Guven Serbest , Ali Riza Demir and Murat Can



The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery.


One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12–18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1–9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated.


RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84–0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89–0.98], p=0.014), TnT (OR: 0.84 [0.68–0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10–6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88–0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41–24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59–24.89], p<0.001).


Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.

Corresponding author: Mustafa Umut Somuncu, MD, Zonguldak Bülent Ecevit Universitesi Tıp Fakultesi Dekanlıgı, Ibn-i Sina Kampusu, 67600 Esenköy/Kozlu, Zonguldak, Turkey, Phone: +90 532 340 1525, Fax: +90 372 261 02 64, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


1. Mozaffarian, D, Benjamin, EJ, Go, AS, Arnett, DK, Blaha, MJ, Cushman, M, et al.. Executive summary: heart disease and stroke statistics—2016 update. Circulation 2016;133:447–54. in Google Scholar

2. Ottervanger, JP, van’t Hof, AW, Reiffers, S, Hoorntje, JC, Suryapranata, H, de Boer, MJ, et al.. Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction. Eur Heart J 2001;22:785–90. in Google Scholar PubMed

3. Goldstein, JA. Right heart ischemia: pathophysiology, natural history, and clinical management. Prog Cardiovasc Dis 1998;40:325–41. in Google Scholar PubMed

4. Andersen, HR, Falk, E, Nielsen, D. Right ventricular infarction: frequency, size and topography in coronary heart disease: a prospective study comprising 107 consecutive autopsies from a coronary care unit. J Am Coll Cardiol 1987;10:1223–32. in Google Scholar PubMed

5. Mehta, SR, Eikelboom, JW, Natarajan, MK, Diaz, R, Yi, C, Gibbons, RJ, et al.. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 2001;37:37–43. in Google Scholar PubMed

6. Roifman, I, Zia, MI, Zavodni, A, Wolff, R, Ghugre, NR, Leber, AW, et al.. Evolution of right ventricular function post-acute ST elevation myocardial infarction. J Magn Reson Imag 2014;40:709–14. in Google Scholar PubMed

7. Huttin, O, Lemarié, J, Meglio, MD, Girerd, N, Mandry, D, Moulinet, F, et al.. Assessment of right ventricular functional recovery after acute myocardial infarction by 2D speckle-tracking echocardiography. Int J Cardiovasc Imag 2015;31:537–45. in Google Scholar PubMed

8. Hoogslag, GE, Haeck, M, Velders, MA, Joyce, E, Boden, H, Schalij, MJ, et al.. Determinants of right ventricular remodeling following ST-segment elevation myocardial infarction. Am J Cardiol 2014;114:1490–6. in Google Scholar PubMed

9. Steen, H, Futterer, S, Merten, C, Jünger, C, Katus, HA, Giannitsis, E. Relative role of NT-pro BNP and cardiac troponin T at 96 hours for estimation of infarct size and leftventricular function after acute myocardialinfarction. J Cardiovasc Magn Reson 2007;9:749–58. in Google Scholar PubMed

10. Lang, RM, Badano, LP, Mor-Avi, V, Afilalo, J, Armstrong, A, Ernande, L, et al.. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1e14–39.e14. in Google Scholar PubMed

11. Rudski, LG, Lai, WW, Afilalo, J, Hua, L, Handschumacher, MD, Chandrasekaran, K, et al.. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685–713. in Google Scholar PubMed

12. Anavekar, NS, Skali, H, Bourgoun, M, Ghali, JK, Kober, L, Maggioni, AP, et al.. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol 2008;101:607–12. in Google Scholar PubMed

13. Gorcsan, JIII, Murali, S, Counihan, PJ, Mandarino, WA, Kormos, RL. Right ventricular performance and contractile reserve in patients with severe heart failure. Assessment by pressure-area relations and association with outcome. Circulation 1996;94:3190–7. in Google Scholar PubMed

14. Hirose, K, Shu, NH, Reed, JE, Rumberger, JA. Right ventricular dilatation and remodeling the first year after an initial transmural wall left ventricular myocardial infarction. Am J Cardiol 1993;72:1126–30. in Google Scholar PubMed

15. Popescu, BA, Antonini-Canterin, F, Temporelli, PL, Giannuzzi, P, Bosimini, E, Gentile, F, et al.. Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudy. Heart 2005;91:484–8. in Google Scholar PubMed PubMed Central

16. Larose, E, Ganz, P, Reynolds, HG, Dorbala, S, Di Carli, MF, Brown, KA, et al.. Right ventricular dysfunction assessed by cardiovascular magnetic resonance imaging predicts poor prognosis late after myocardial infarction. J Am Coll Cardiol 2007;49:855–62. in Google Scholar PubMed

17. Sakata, K, Yoshino, H, Kurihara, H, Iwamori, K, Houshaku, H, Yanagisawa, A, et al.. Prognostic significance of persistent right ventricular dysfunction as assessed by radionuclide angiocardiography in patients with inferior wall acute myocardial infarction. Am J Cardiol 2000;85:939–44. in Google Scholar PubMed

18. Masci, PG, Francone, M, Desmet, W, Ganame, J, Todiere, G, Donato, R, et al.. Right ventricular ischemic injury in patients with acute ST-segment elevation myocardial infarction: characterization with cardiovascular magnetic resonance. Circulation 2010;122:1405–12. in Google Scholar

19. Nambi, V, Liu, X, Chambless, LE, Lemos, J, Virani, S, Agarwal, S, et al.. Troponin T and N-terminal pro-B-type natriuretic peptide: a biomarker approach to predict heart failure risk–the atherosclerosis risk in communities study. Clin Chem 2013;59:1802–10. in Google Scholar PubMed PubMed Central

20. Blankenberg, S, Rupprecht, HJ, Bickel, C, Torzewski, M, Hafner, G, Tiret, L, et al.. Glutathione peroxidase 1 activity and cardiovascular events in patients with coronary artery disease. N Engl J Med 2003;349:1605–13. in Google Scholar

21. Karakas, M, Schulte, C, Appelbaum, S, Ojeda, F, Lackner, KJ, Münzel, T, et al.. Circulating microRNAs strongly predict cardiovascular death in patients with coronary artery disease-results from the large AtheroGene study. Eur Heart J 2017;38:516–23. in Google Scholar PubMed

22. Wang, TJ, Gona, P, Larson, MG, Tofler, GH, Levy, D, Newton-Cheh, C, et al.. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med 2006;355:2631–9. in Google Scholar

23. Willeit, P, Kaptoge, S, Welsh, P, Butterworth, A, Chowdhury, R, Spackman, S, et al.. Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. Lancet Diabetes Endocrinol 2016;4:840–9. in Google Scholar

24. Tulevski, II, Ten Wolde, M, van Veldhuisen, DJ, Mulder, J, van der Wall, EE, Büller, HR, et al.. Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism. Int J Cardiol 2007;116:161–6. in Google Scholar PubMed

25. Goldhaber, SZ. Assessing the prognosis of acute pulmonary embolism: tricks of the trade. Chest 2008;133:334–6. in Google Scholar PubMed

26. Goldstein, JA, Tweddell, JS, Barzilai, B, Jaffe, AS, Cox, JL. Importance of left ventricular function and systolic ventricular interaction to right ventricular performance during acute right heart ischemia. J Am Coll Cardiol 1992;19:704–11. in Google Scholar PubMed

27. Moller, JE, Sondergaard, E, Poulsen, SH, Appleton, CP, Egstrup, K. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction. J Am Soc Echocardiogr 2001;14:249–55. in Google Scholar PubMed

28. Manhenke, C, Orn, S, Squire, I, Radauceanu, A, Alla, F, Zannad, F, et al.. The prognostic value of circulating markers of collagen turnover after acute myocardial infarction. Int J Cardiol 2011;150:277–82. in Google Scholar PubMed

29. Vignon, P, Spencer, KT, Mor-Avi, V, Weinert, L, Lang, RM. Evaluation of global and regional right ventricular function using automated border detection techniques. Echocardiography 1999;16:105–16. in Google Scholar PubMed

Received: 2021-02-23
Accepted: 2021-11-02
Published Online: 2021-11-18

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 2.12.2023 from
Scroll to top button