Natriuretic peptide biomarkers as information indicators in elderly patients with possible heart failure followed over six years: a head-to-head comparison of four cardiac natriuretic peptides.
BACKGROUND
Little is known about the differences between natriuretic peptides used to evaluate elderly patients with heart failure. The aim of the study was to evaluate the information and the power to predict cardiovascular mortality derived from an analysis of cardiac natriuretic peptides from the same study population and at the same time.


RESULTS
In all, 415 elderly patients (age 65-82 years) in primary health care were evaluated and followed for 6 years. All patients had symptoms of heart failure and were examined by a cardiologist. An electrocardiogram and chest x-rays were taken, and the systolic and diastolic functions were assessed using Doppler echocardiography. Brain natriuretic peptide (BNP), N-terminal proBNP, atrial natriuretic peptide (ANP), and N-terminal proANP were analyzed. All 4 peptides were associated with age, and only 1 of them showed any gender difference. Three of the 4 peptides (not ANP) provided important information for identifying patients with impaired systolic function and diastolic dysfunction (pseudonormal or restrictive filling pattern), and for assessing the risk of cardiovascular death.


CONCLUSIONS
Cardiac natriuretic peptides are useful tools for evaluating elderly patients with heart failure. Three of the 4 peptides were very similar. ANP exhibits inferior properties and cannot be recommended in clinical practice.
Alehagen
Urban
U
From the Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
Svensson
Erland
E
Dahlström
Ulf
U
D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D015592:Immunoradiometric Assay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor