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.
OBJECTIVE
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.
Moertl
Deddo
D
Department of Cardiology, Medical University of Vienna, Vienna, Austria. deddo.moertl@meduniwien.ac.at
Berger
Rudolf
R
Struck
Joachim
J
Gleiss
Andreas
A
Hammer
Alexandra
A
Morgenthaler
Nils G
NG
Bergmann
Andreas
A
Huelsmann
Martin
M
Pacher
Richard
R
D009320:Atrial Natriuretic Factor / Q000097:blood*; D016001:Confidence Intervals; D005260:Female; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000401:mortality / Q000503:physiopathology*
D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor