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CLINICAL RESEARCH: HEART FAILURE

Comparison of Midregional Pro-Atrial and B-Type Natriuretic Peptides in Chronic Heart Failure

Influencing 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

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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