Neuroendocrine testing in community patients with heart disease: plasma N-terminal proatrial natriuretic peptide predicts morbidity and mortality stronger than catecholamines and heart rate variability.
BACKGROUND
Patients with heart disease are at risk of developing congestive heart failure (CHF). Neurohormonal activation may make an important contribution.


OBJECTIVE
In stable heart patients from primary care, to examine neuroendocrine markers of cardiac performance for the association to cardiac dysfunction, morbidity and mortality.


METHODS
Plasma N-terminal atrial natriuretic peptide (N-ANP), catecholamines, 24-h ECG and blood pressure, serum urea and creatinine, echocardiography, chest X-ray and physical examination were performed. Death was recorded during 5 to 7 years of follow-up.


RESULTS
The study included 56 patients. Mean age was 71 years, 54% were men, 43% had clinical signs of CHF, 39 + 52 + 9% were in NYHA I + II + III, 34% had echocardiographic cardiac dysfunction, and 18 died during follow-up. N-ANP was related to all subtypes of cardiac dysfunction (p < 0.05). Catecholamines and premature ventricular captures (PVC) were related to valvular and systolic dysfunction, but heart rate variability and dipping blood pressure were not (p > 0.05). On multivariate analyses only, N-ANP and PVC were associated with clinical signs of CHF, echocardiographic cardiac dysfunction, and mortality (p < 0.05).


CONCLUSIONS
Plasma N-ANP was stronger than catecholamines and variables of 24-h monitoring (blood pressure and electrocardiogram) in predicting morbidity and mortality, thereby supporting the use of cardiac natriuretic peptides (i.e. N-ANP, BNP, or N-BNP) as the most valuable biomarker in community patients at risk of CHF.
Nielsen
O W
OW
Cardiology Department Y, Bispebjerg Hospital, DK-2200 Copenhagen, Denmark. own@dadlnet.dk
Rasmussen
V
V
Christensen
N J
NJ
Hansen
J F
JF
D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D003153:Community Health Services; D004837:Epinephrine / Q000097:blood*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D006333:Heart Failure / Q000175:diagnosis; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009638:Norepinephrine / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index
C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine; D004837:Epinephrine