title: Direct comparison of mid-regional pro-atrial natriuretic peptide with N-terminal pro B-type natriuretic peptide in the diagnosis of patients with atrial fibrillation and dyspnoea.
abstract: OBJECTIVE
  Due to different release mechanisms, mid-regional pro-atrial natriuretic peptide (MR proANP) may be superior to N-terminal pro-B-type natriuretic peptide (NT proBNP) in the diagnosis of acute heart failure (AHF) in patients with atrial fibrillation (AF). We compared MR proANP and NT proBNP for their diagnostic value in patients with AF and sinus rhythm (SR).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University hospital, emergency department.
  
  
  METHODS
  632 consecutive patients presenting with acute dyspnoea.
  
  
  METHODS
  MR proANP and NT proBNP plasma levels were determined. The diagnosis of AHF was adjudicated by two independent cardiologists using all available data. Patients received long-term follow-up.
  
  
  RESULTS
  AF was present in 151 patients (24%). MR proANP and NT proBNP levels were significantly higher in the AF group compared with the SR group (385 (258-598) versus 201 (89-375) pmol/l for MR proANP, p<0.001 and 4916 (2169-10285) versus 1177 (258-5166) pg/ml, p<0.001 for NT proBNP). Diagnostic accuracy in AF patients was similar for MR proANP (0.90, 95% CI 0.84 to 0.95) and NT proBNP (0.89, 95% CI 0.81 to 0.96). Optimal cut-off levels in AF patients were significantly higher compared with the optimal cut-off levels for patients in SR (MR proANP 240 vs 200 pmol/l; NT proBNP 2670 vs 1500 pg/ml respectively). After adjustment in multivariable Cox proportional hazard analysis, MR proANP strongly predicted one-year all-cause mortality (HR=1.13 (1.09-1.17), per 100 pmol/l increase, p<0.001).
  
  
  CONCLUSIONS
  In AF patients, NT proBNP and MR proANP have similar diagnostic value for the diagnosis of AHF. The rhythm at presentation has to be taken into account because plasma levels of both peptides are significantly higher in patients with AF compared with SR.
authors.affiliation: Department of Medicine, University Hospital Basel, Basel, Switzerland. ecksteinj@uhbs.ch
authors.forename: Jens
authors.initials: J
authors.lastname: Eckstein
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Karsten
authors.initials: K
authors.lastname: Murray
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Ronny
authors.initials: R
authors.lastname: Ziller
authors.forename: Tamina
authors.initials: T
authors.lastname: Mosimann
authors.forename: Theresia
authors.initials: T
authors.lastname: Klima
authors.forename: Rebeca
authors.initials: R
authors.lastname: Hoeller
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Seoung Mann
authors.initials: SM
authors.lastname: Sou
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D009320:Atrial Natriuretic Factor; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors; D015203:Reproducibility of Results
chemical_list: 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