CLINICAL RESEARCH: HEART FAILURE
Comparison of Midregional Pro-Atrial and B-Type Natriuretic Peptides in Chronic Heart FailureInfluencing Factors, Detection of Left Ventricular Systolic Dysfunction, and Prediction of Death
Deddo Moertl, MD*,*,
Rudolf Berger, MD*,
Joachim Struck, PhD ,
Andreas Gleiss, PhD ,
Alexandra Hammer, MD*,
Nils G. Morgenthaler, MD ,
Andreas Bergmann, PhD ,
Martin Huelsmann, MD* and
Richard Pacher, MD*
* Department of Cardiology, Medical University of Vienna, Vienna, Austria
Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria
B.R.A.H.M.S. AG, Department of Research, Hennigsdorf/Berlin, Germany
Manuscript received November 29, 2008;
revised manuscript received January 16, 2009,
accepted January 25, 2009.
* Reprint requests and correspondence: Dr. Deddo Moertl, Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (Email: deddo.moertl{at}meduniwien.ac.at).
Objectives: Midregional pro-atrial natriuretic peptide (MR-proANP) was assessed for the importance of influencing factors, the ability to detect left ventricular systolic dysfunction, and the prognostic power compared with B-type natriuretic peptide (BNP) and amino-terminal pro–B-type natriuretic peptide (NT-proBNP) in chronic heart failure (HF).
Background: MR-proANP is a biologically stable natriuretic peptide measured by a recently developed assay, with potential advantages over conventional natriuretic peptides such as BNP and NT-proBNP.
Methods: We measured MR-proANP, BNP, and NT-proBNP in 797 patients with chronic HF.
Results: All 3 natriuretic peptides were independently influenced by left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and the presence of ankle edema. Area under receiver-operator characteristic curves for detection of an LVEF <40% were similar between MR-proANP (0.799 [95% confidence interval (CI): 0.753 to 0.844]), BNP (0.803 [95% CI: 0.757 to 0.849]), and NT-proBNP (0.730 [95% CI: 0.681 to 0.778]). During a median observation time of 68 months, 492 (62%) patients died. In multiple Cox regression analysis each natriuretic peptide was the strongest prognostic parameter among various clinical variables. Proportion of explained variation showed that NT-proANP (4.36%) was a significantly stronger predictor of death than both NT-proBNP (2.47%, p < 0.0001) and BNP (2.42%, p < 0.0001).
Conclusions: Despite similarities in influencing factors and detection of reduced LVEF, MR-proANP outperformed BNP and NT-proBNP in the prediction of death. A new assay technology and the high biological stability of MR-proANP are potential explanations for these findings.
Key Words: chronic heart failure natriuretic peptides prognosis
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Abbreviations and Acronyms
| | ANP = atrial natriuretic peptide | | AUC = area under curve | | BMI = body mass index | | BNP = B-type natriuretic peptide | | GFR = glomerular filtration rate | | HF = heart failure | | LVEF = left ventricular ejection fraction | | MR-proANP = midregional pro-atrial natriuretic peptide | | NT-proANP = amino-terminal pro-atrial natriuretic peptide | | NT-proBNP = amino-terminal pro–B-type natriuretic peptide | | NYHA = New York Heart Association | | PEV = proportion of explained variation | | ROC = receiver-operating characteristic |
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J. Am. Coll. Cardiol. 2009 53: A30.
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