title: Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial.
abstract: OBJECTIVE
  Our purpose was to assess the diagnostic utility of mid-regional pro-atrial natriuretic peptide (MR-proANP) for the diagnosis of acute heart failure (AHF) and the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with AHF.
  
  
  BACKGROUND
  There are some caveats and limitations to natriuretic peptide testing in the acute dyspneic patient.
  
  
  METHODS
  The BACH (Biomarkers in Acute Heart Failure) trial was a prospective, 15-center, international study of 1,641 patients presenting to the emergency department with dyspnea. A noninferiority test of MR-proANP versus B-type natriuretic peptide (BNP) for diagnosis of AHF and a superiority test of MR-proADM versus BNP for 90-day survival were conducted. Other end points were exploratory.
  
  
  RESULTS
  MR-proANP (> or =120 pmol/l) proved noninferior to BNP (> or =100 pg/ml) for the diagnosis of AHF (accuracy difference 0.9%). In tests of secondary diagnostic objectives, MR-proANP levels added to the utility of BNP levels in patients with intermediate BNP values and with obesity but not in renal insufficiency, the elderly, or patients with edema. Using cut-off values from receiver-operating characteristic analysis, the accuracy to predict 90-day survival of heart failure patients was 73% (95% confidence interval: 70% to 77%) for MR-proADM and 62% (95% confidence interval: 58% to 66%) for BNP (difference p < 0.001). In adjusted multivariable Cox regression, MR-proADM, but not BNP, carried independent prognostic value (p < 0.001). Results were consistent using NT-proBNP instead of BNP (p < 0.001). None of the biomarkers was able to predict rehospitalization or visits to the emergency department with clinical relevance.
  
  
  CONCLUSIONS
  MR-proANP is as useful as BNP for AHF diagnosis in dyspneic patients and may provide additional clinical utility when BNP is difficult to interpret. MR-proADM identifies patients with high 90-day mortality risk and adds prognostic value to BNP. (Biomarkers in Acute Heart Failure [BACH]; NCT00537628).
authors.affiliation: VA San Diego Healthcare System, San Diego, California 92161, USA. amaisel@ucsd.edu
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Judd W
authors.initials: JW
authors.lastname: Landsberg
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.forename: Christopher
authors.initials: C
authors.lastname: Hogan
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Garret
authors.initials: G
authors.lastname: Terracciano
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kremastinos
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: C507862:ADM protein, human; D015415:Biomarkers; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor