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  • Superiority of proatrial natriuretic peptide in the prognostic power in patients with acute decompensated heart failure on hospital admission: comparison with B-type natriuretic peptide and other natriuretic peptide forms

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Heart failure and cardiomyopathies
Original research article
Superiority of proatrial natriuretic peptide in the prognostic power in patients with acute decompensated heart failure on hospital admission: comparison with B-type natriuretic peptide and other natriuretic peptide forms
  1. Seiji Takashio1,
  2. Hiroyuki Takahama1,
  3. Toshio Nishikimi2,
  4. Tomohiro Hayashi1,
  5. Chiaki Nagai-Okatani3,
  6. Ayaka Matsuo4,
  7. Yasuaki Nakagawa2,
  8. Masashi Amano1,
  9. Yasuhiro Hamatani1,
  10. Atsushi Okada1,
  11. Makoto Amaki1,
  12. Takuya Hasegawa1,
  13. Hideaki Kanzaki1,
  14. Satoshi Yasuda1,
  15. Kenji Kangawa5,
  16. Toshihisa Anzai1,6,
  17. Naoto Minamino3,4 and
  18. Chisato Izumi1
  1. 1 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
  2. 2 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
  3. 3 Department of Molecular Pharmacology, National Cerebral and Cardiovascular Center, Suita, Japan
  4. 4 Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
  5. 5 Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan
  6. 6 Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  1. Correspondence to Dr Hiroyuki Takahama, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan; takahama{at}ncvc.go.jp

Abstract

Aims There are significant differences in how atrial (A-type) and B-type natriuretic peptide (ANP and BNP) are secreted and metabolised, but there is little information available about the relative clinical significance of the two peptides. The aim of the present study was to investigate: (1) the association between the circulating level of each ANP molecular form and patient clinical background and (2) their prognostic power for patients with acute decompensated heart failure (ADHF).

Methods We used specific chemiluminescence enzyme immunoassays to prospectively evaluate the levels of six bioactive molecular forms of ANP (pro-ANP, β-ANP and total ANP) and BNP (pro-BNP, N-terminal pro-BNP (NT-pro-BNP) and total BNP) in plasma samples collected from 173 patients with ADHF on their hospital admission.

Results We found that pro-ANP levels were strongly associated with left ventricular (LV) size and ejection fraction (p<0.001), but were not associated with left atrial size. Percent pro-ANP ([pro-ANP/total ANP]x100) was also associated with LV size and function. During the follow-up term (median: 469 days), composite adverse events (all causes of death or rehospitalisation for HF) occurred in 67 patients (38.7 %). Pro-ANP was significantly associated with composite adverse events even after adjusting by estimated glomerular filtration rate (eGFR) (p<0.05). In contrast, NT-pro-BNP was not independent of eGFR in the multivariate analysis.

Conclusion Circulating levels of pro-ANP are strongly associated with LV function and clinical outcomes of patients with ADHF. These findings suggest that during the acute phases of HF, pro-ANP has a prognostic power comparable with NT-pro-BNP independently of renal function.

  • natriuretic peptide
  • acute heart failure
  • atrial natriuretic peptide
  • and b-type natriuretic peptide

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001072

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    Footnotes

    • Contributors HT, TA and NM contributed to design of the work; ST, HT, TH, CN-O, AM, MA, YH, AO, MA, TH and HK contributed to the acquisition and analysis of data for the work; YN, AO, SY, KK and CI contributed to interpretation of data for the work; ST, HT, TN, YN, SY, NM and CI contributed to drafting the work or revising it critically for important intellectual content; Final approval of the version was done by HT.

    • Funding This work was supported in part by the Intramural Research Fund of the National Cerebral and Cardiovascular Center of Japan (grants 22-1-4 and 27-1-5 to N.M.) and a Grant-in-aid for Scientific Research from the Japan Society for the Promotion of Science (grant number: 18K08057 to H.T).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by our institutional ethics committee (M23-090) and was conducted in accordance with the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.