Clinical Research
Heart Failure
Comparison of Midregional Pro-Atrial and B-Type Natriuretic Peptides in Chronic Heart Failure: Influencing Factors, Detection of Left Ventricular Systolic Dysfunction, and Prediction of Death

https://doi.org/10.1016/j.jacc.2009.01.057Get rights and content
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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.

Key Words

chronic heart failure
natriuretic peptides
prognosis

Abbreviations and Acronyms

ANP
atrial natriuretic peptide
AUC
area under curve
BMI
body mass index
BNP
B-type natriuretic peptide
GFR
glomerular filtration rate
HF
heart failure
LVEF
left ventricular ejection fraction
MR-proANP
midregional pro-atrial natriuretic peptide
NT-proANP
amino-terminal pro-atrial natriuretic peptide
NT-proBNP
amino-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
PEV
proportion of explained variation
ROC
receiver-operating characteristic

Cited by (0)

Dr. Bergmann is a member of the board of directors of and holds ownership in B.R.A.H.M.S. AG (MR-proANP). Drs. Struck and Morgenthaler are employees of B.R.A.H.M.S. AG. Drs. Bergmann and Struck hold patent rights to MR-proANP.