RT Journal Article
SR Electronic
T1 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
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001072
DO 10.1136/openhrt-2019-001072
VO 6
IS 2
A1 Seiji Takashio
A1 Hiroyuki Takahama
A1 Toshio Nishikimi
A1 Tomohiro Hayashi
A1 Chiaki Nagai-Okatani
A1 Ayaka Matsuo
A1 Yasuaki Nakagawa
A1 Masashi Amano
A1 Yasuhiro Hamatani
A1 Atsushi Okada
A1 Makoto Amaki
A1 Takuya Hasegawa
A1 Hideaki Kanzaki
A1 Satoshi Yasuda
A1 Kenji Kangawa
A1 Toshihisa Anzai
A1 Naoto Minamino
A1 Chisato Izumi
YR 2019
UL http://openheart.bmj.com/content/6/2/e001072.abstract
AB 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.