title: Influence of age, race, sex, and body mass index on interpretation of midregional pro atrial natriuretic peptide for the diagnosis of acute heart failure: results from the BACH multinational study.
abstract: OBJECTIVE
  Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF.
  
  
  RESULTS
  The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90 % sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old.
  
  
  CONCLUSIONS
  Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity.
authors.affiliation: University of California-San Diego, La Jolla, CA, USA. lbdaniels@ucsd.edu
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
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: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers; D015992:Body Mass Index; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D044469:Racial Groups; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D009320:Atrial Natriuretic Factor