130 - NT-pro BNP e angina instabile

M. Lotzniker, N. Covini, G. Re, S. Finazzi, C. Inserra, R. Pacifici, P.G. Zuccaro Nt-pro BNP in unstable coronary artery disease.Introduction. The natriuretic peptides and, more recently, the N-terminal fragment of Brain Natriuretic Peptide (NTproBNP) caused great interest both in monitoring cardiac insufficiency and in the risk stratification in acute coronary disease. Anyway, the knowledge of the mechanism of natriuretic peptides synthesis, release and regulation is still incomplete. Besides myocardial necrosis any inflammatory state may be considered a possible factor inducing their increase. Materials and methods. In order to pointout the importance of these two factors, besides NT-proBNP, Troponin T, PCR and cytokines (IL1b, IL6, IL10, IL18, IL1Ra) were tested in 58 patients with unstable angina when entering the coronary unit. Results. NT-proBNP reveals a positive correlation with proinflammatory cytokines IL6 and IL18 and a negative one with IL1b and IL10. In case of necrosis NT-proBNP and IL6 medians reveal a significant increase; on the contrary IL10 medians reveal a decrease. The severity of the coronary disease valued according to the mono/plurivessel affection is characterised by an increase of NT-proBNP with a reduced concentration of IL1b. Conclusions. In unstable angina NT-proBNP represents an efficacious global marker of the damage caused by ischemia because of the several activation mechanisms involved. NTproBNP and cytokines reveal a dynamic and different relations, showing that natriuretic peptides have a immunomodulant role in addition to the better known cardiovascular effects.