N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction.
BACKGROUND
Atrial natriuretic factor (ANF) is a peptide hormone secreted from cardiac atria in response to increased atrial pressure. Because of a longer half-life and greater stability, the N-terminal of ANF prohormone (N-terminal proANF) may be a better integrator of atrial peptide secretion than ANF itself. After myocardial infarction, elevation of ANF and other neurohormones has been associated with a poor prognosis. However, when left ventricular ejection fraction (LVEF) and other important clinical variables are included in multivariate analysis, the independent predictive value of these neurohormones has been reduced markedly.


RESULTS
To test the prognostic value of N-terminal proANF after myocardial infarction, its plasma concentration was measured a mean of 12 days after infarction in 246 patients in the Survival and Ventricular Enlargement (SAVE) Study. N-terminal proANF was a much stronger predictor of survival than ANF itself. Furthermore, in multivariate analysis of cardiovascular mortality and development of heart failure, N-terminal proANF in contrast to ANF and other neurohormones was still a powerful and independent predictor when the model included age, gender, prior myocardial infarction, hypertension, diabetes, use of thrombolysis, Killip class, infarct location, and LVEF.


CONCLUSIONS
The measurement of N-terminal proANF supplements presently used clinical and objective assessments and provides an important independent predictor of prognosis with respect to cardiovascular mortality and development of heart failure.
Hall
C
C
Institute for Surgical Research, University of Oslo, Norway.
Rouleau
J L
JL
Moyè
L
L
de Champlain
J
J
Bichet
D
D
Klein
M
M
Sussex
B
B
Packer
M
M
Rouleau
J
J
Arnold
M O
MO
D009320:Atrial Natriuretic Factor / Q000097:blood*; D002216:Captopril / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D010446:Peptide Fragments; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D013997:Time Factors
D010446:Peptide Fragments; D011498:Protein Precursors; C055659:atrial natriuretic factor prohormone (1-98); D009320:Atrial Natriuretic Factor; D002216:Captopril