title: Comparison of the diagnostic and prognostic values of B-type and atrial-type natriuretic peptides in acute heart failure.
abstract: BACKGROUND
  We compared diagnostic and prognostic properties of brain natruiretic peptide (BNP), proBNP, NT-proBNP and MR-pro-atrial natriuretic peptide (ANP) in patients admitted with shortness of breath (SOB).
  
  
  METHODS
  All 4 NPs were measured in patients admitted to the emergency unit with SOB (in 2 centers) or acute heart failure (AHF) (1 FINN-AKVA cohort) and in a control population of stable chronic HF. Follow-up was 1 (2 centers) and 5 years (1 FINN-AKVA cohort). Area under the curve (AUC) was used to assess diagnostic properties. AUC, multivariate Cox regression, net reclassification improvement (NRI), and Kaplan-Meier analyses were used to assess mortality.
  
  
  RESULTS
  We included 710 patients ("Biomarcoeurs" cohort n=336; FINN-AKVA study, n=306; stable chronic HF, n=68). Pro-BNP was almost as powerful as BNP to diagnose AHF (AUC 0.953 vs 0.973 respectively, p=0.003), NT-proBNP also performed well (0.922, p<0.001 vs BNP). MR-proANP performed less well (0.901). AUC over time showed greater MR-proANP values over the first year. At 5 years, MR-proANP had the best prognostic value (AUC 0.668 vs 0.604 for BNP, p=0.042). Kaplan Meier analysis confirmed better survival with MR-proANP≤416.8 pmol/L at 5 years. NRI at 5 years was greater for MR-proANP (0.23, p<0.05) than for proBNP, BNP or NTproBNP (p=NS).
  
  
  CONCLUSIONS
  Our study provides firm evidence that all NPs perform equally well for diagnostic purposes, and that MR-proANP has long term prognostic value in patients with acute heart failure.
authors.affiliation: Department of Cardiology EA3920, University Hospital Jean Minjoz, Besancon, France; UMRS 942 Inserm, 75010 Paris, France.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Seronde
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.forename: Riadh
authors.initials: R
authors.lastname: Boukef
authors.forename: Franck
authors.initials: F
authors.lastname: Sibellas
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Launay
authors.forename: Philippe
authors.initials: P
authors.lastname: Manivet
authors.forename: Malha
authors.initials: M
authors.lastname: Sadoune
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
authors.forename: Alain Cohen
authors.initials: AC
authors.lastname: Solal
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor
keywords: Acute heart failure; Atrial-type natriuretic peptides; B-type natriuretic peptides; Diagnosis; Prognosis