title: Plasma N-terminal proatrial natriuretic factor can predict normal pulmonary capillary wedge pressure in cardiac transplant recipients.
abstract: BACKGROUND
  Plasma N-terminal proatrial natriuretic factor (proANP) is closely related to atrial filling pressure, but this may be distorted in heart transplant recipients.
  
  
  OBJECTIVE
  The aim of this study was to examine the usefulness of proANP as a non-invasive marker of cardiac filling pressure in transplanted patients with normal to moderately elevated serum creatinine (s-creatinine).
  
  
  METHODS
  Blood was sampled at rest for analysis of proANP from 220 patients 1-13 (median 4) years after orthotopic heart transplantation undergoing routine diagnostic catheterization.
  
  
  RESULTS
  In multivariate analysis proANP was significantly positively related to s-creatinine, mean pulmonary capillary wedge pressure (PCWP) and time after transplantation and negatively related to haemoglobin and cardiac index. All the patients with proANP below 1140 pmol/l had normal PCWP (<13 mmHg). The area under the receiver-operating characteristic curve for proANP for the detection of PCWP > 13 mmHg was 0.81. The positive predictive value of proANP for detection of increased PCWP was very low.
  
  
  CONCLUSIONS
  A low proANP had a 100% negative predictive value for increased atrial pressure but the low positive predictive value makes proANP unsuitable as an indicator of increased atrial pressures in heart transplanted patients.
authors.affiliation: Department of Cardiology, Rikshospitalet, University Hospital, Oslo, Norway. mortiz@powertech.no
authors.forename: M G
authors.initials: MG
authors.lastname: Dahle
authors.forename: L
authors.initials: L
authors.lastname: Gullestad
authors.forename: S
authors.initials: S
authors.lastname: Simonsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016275:Atrial Function; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D003404:Creatinine / Q000097:blood; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011498:Protein Precursors / Q000097:blood*; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D009320:Atrial Natriuretic Factor; D003404:Creatinine