Comparison of Midregional Pro-Atrial and B-Type Natriuretic Peptides in Chronic Heart Failure

• Published in: Journal of the American College of Cardiology Vol. 53; no. 19; pp. 1783 - 1790
• Main Authors: Moertl, Deddo, MD, Berger, Rudolf, MD, Struck, Joachim, PhD, Gleiss, Andreas, PhD, Hammer, Alexandra, MD, Morgenthaler, Nils G., MD, Bergmann, Andreas, PhD, Huelsmann, Martin, MD, Pacher, Richard, MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 12.05.2009
• Subjects: Cardiovascular; chronic heart failure; Internal Medicine; natriuretic peptides; prognosis; PEV; ANP; BNP; LVEF; chronic heart failure; left ventricular ejection fraction; AUC; NT-proANP; natriuretic peptides; New York Heart Association; area under curve; GFR; NT-proBNP; receiver-operating characteristic; MR-proANP; amino-terminal pro-atrial natriuretic peptide; atrial natriuretic peptide; BMI; midregional pro-atrial natriuretic peptide; NYHA; heart failure; amino-terminal pro–B-type natriuretic peptide; glomerular filtration rate; body mass index; ROC; prognosis; B-type natriuretic peptide; proportion of explained variation; HF
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.01.057

Objectives Midregional pro-atrial natriuretic peptide (MR-proANP) was assessed for the importance of influencing factors, the ability to detect left ventricular systolic dysfunction, and the prognostic power compared with B-type natriuretic peptide (BNP) and amino-terminal pro–B-type natriuretic peptide (NT-proBNP) in chronic heart failure (HF). Background MR-proANP is a biologically stable natriuretic peptide measured by a recently developed assay, with potential advantages over conventional natriuretic peptides such as BNP and NT-proBNP. Methods We measured MR-proANP, BNP, and NT-proBNP in 797 patients with chronic HF. Results All 3 natriuretic peptides were independently influenced by left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and the presence of ankle edema. Area under receiver-operator characteristic curves for detection of an LVEF <40% were similar between MR-proANP (0.799 [95% confidence interval (CI): 0.753 to 0.844]), BNP (0.803 [95% CI: 0.757 to 0.849]), and NT-proBNP (0.730 [95% CI: 0.681 to 0.778]). During a median observation time of 68 months, 492 (62%) patients died. In multiple Cox regression analysis each natriuretic peptide was the strongest prognostic parameter among various clinical variables. Proportion of explained variation showed that NT-proANP (4.36%) was a significantly stronger predictor of death than both NT-proBNP (2.47%, p < 0.0001) and BNP (2.42%, p < 0.0001). Conclusions Despite similarities in influencing factors and detection of reduced LVEF, MR-proANP outperformed BNP and NT-proBNP in the prediction of death. A new assay technology and the high biological stability of MR-proANP are potential explanations for these findings.