title: Atrial fibrillation impairs the diagnostic performance of cardiac natriuretic peptides in dyspneic patients: results from the BACH Study (Biomarkers in ACute Heart Failure).
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients.
  
  
  BACKGROUND
  The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported.
  
  
  METHODS
  A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF.
  
  
  RESULTS
  AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality.
  
  
  CONCLUSIONS
  AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.
authors.affiliation: University of Otago, Christchurch, New Zealand; National University Heart Centre, Singapore. Electronic address: Mark.Richards@cdhb.health.nz.
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.affiliation: Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.affiliation: The Cleveland Clinic, Cleveland, Ohio.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Medical University, Faculty of Public Health, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Charite, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hogan
authors.affiliation: University of California San Francisco, California.
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Veterans' Administration San Diego Healthcare System, San Diego, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Athens University Hospital Attikon, Athens, Greece.
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.affiliation: Veterans' Administration Minneapolis, Minnesota.
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.affiliation: University of Leicester, Leicester, United Kingdom.
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
authors.affiliation: University of California San Diego, California.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: University of Maryland, Baltimore, Maryland.
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.affiliation: Sant'Andrea Hospital, University La Sapienza, Rome, Italy; Veterans' Administration San Diego Healthcare System, San Diego, California.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.affiliation: University of Maryland, Baltimore, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.affiliation: BRAHMS Aktiengesellschaft Biotechnology Centre Hennigsdorf, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.affiliation: Charite, Campus Virchow-Klinikum, Berlin, Germany; Centre for Clinical and Basic Research IRCCS, San Raffaele, Roma, Italy.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: University of California San Diego, California.
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications; 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; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D009320:Atrial Natriuretic Factor
keywords: atrial fibrillation; heart failure; natriuretic peptides