The role of urine neutrophil gelatinase - associated lipocalin (NGAL) in acute heart failure in patients with ST - elevation myocardial infarction

Abstract

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is a novel early marker of acute kidney injury for which has been shown that it can also be released from the injured myocardium. Our aim was to correlate urine NGAL with markers of in-hospital heart failure in patients with acute ST-elevation myocardial infarction (STEMI). Methods: We prospectively included 61 consecutive STEMI patients after primary percutaneous coronary intervention and estimated admission and in-hospital urine NGAL, serum creatinine, troponin I, leucocytes, CRP, N-terminal pro brain natriuretic peptide (NT-proBNP) levels and ejection fraction by echocardiography. Urine NGAL levels were compared between patients with and without HF defined as serum NT-proBNP > 400 pmol/l and were correlated to markers of heart failure, inflammations and of kidney function. Results: Urine NGAL levels and CRP was significantly higher in participants with heart failure compared to those with NT-proBNP below 400 pmol/l. Urine NGAL level of 50 ng/ml had 90 % specificity for HF, the sensitivity was low at 25 %. Comparison of participants with NGAL levels < 50 ng/ml and ≥ 50 ng/ml at admission and after 12 h revealed a significant difference in NT-proBNP levels, left ventricle ejection fraction, markers of inflammation and of kidney function. Urine NGAL level was independently associated with NT-proBNP level. Conclusions: The level of urine NGAL early after myocardial infarction is associated with NT-proBNP concentration and even NGAL levels below 137 ng/ml, the usually reported normal cut-off value, had high specificity for HF in our sample.