Relation of natriuretic peptides and midregional proadrenomedullin to cardiac chamber volumes by computed tomography in patients without heart failure: from the ROMICAT Trial.
BACKGROUND
Stress myocyte biomarkers are used prognostically in patients with cardiovascular disease. We examined associations between amino-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) concentrations and cardiac chamber volumes in chest pain patients without heart failure by use of computed tomography (CT).


METHODS
At the time of 64-slice CT scan, we acquired plasma and serum samples for these biomarkers from 346 patients [mean (SD) age 53 (12) years, 65% men]. Left atrial volume (LAV) and left ventricular volumes at end-diastole (LVEDV) and end-systole (LVESV) were measured and indexed to body surface area (LAVI, LVEDI, LVESI).


RESULTS
Concentrations of both natriuretic peptides were correlated with LAV and LAVI (r = 0.19-0.32, all P <or= 0.0005) and MR-proADM with LV volumes and indices (r = -0.14 to -0.21, all P <or= 0.01). NT-proBNP and MR-proANP concentrations were higher in the top quartiles of patients than the lowest quartiles using LAV and LAVI, whereas MR-proADM concentrations were lower in the top quartiles of LV measures. In adjusted analyses, patients had 2- to 4-fold increased risk of LA enlargement for every incremental increase in log(10)NT-proBNP [LAV odds ratio (OR) 2.4, P = 0.03; LAVI OR 4.0, P = 0.003] and 10- to 13-fold increased risk of LA enlargement for every incremental increase in log(10)MR-proANP (LAV OR 10.7, P = 0.009; LAVI OR 13.1, P = 0.004).


CONCLUSIONS
In patients without heart failure, both NT-proBNP and MR-proANP concentrations are independently associated with LA enlargement, whereas MR-proADM concentrations are correlated with LV volumes. This may partially explain the well-recognized value of natriuretic peptides for use in risk stratification.
Truong
Quynh A
QA
Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. qtruong@partners.org
Siegel
Emily
E
Karakas
Mahir
M
Januzzi
James L
JL
Bamberg
Fabian
F
Mahabadi
Amir A
AA
Dasdemir
Selcuk
S
Brady
Thomas J
TJ
Bergmann
Andreas
A
Kunde
Jan
J
Nagurney
John T
JT
Hoffmann
Udo
U
Koenig
Wolfgang
W
D053607:Adrenomedullin / Q000097:blood*; D016279:Atrial Function, Left; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left
D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin