Comparison of Midregional Pro-Atrial Natriuretic Peptide With N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Survival in Patients With Chronic Heart Failure

Stephan von Haehling, Ewa A. Jankowska, Nils G. Morgenthaler, Corrado Vassanelli, Luisa Zanolla, Piotr Rozentryt, Gerasimos S. Filippatos, Wolfram Doehner, Friedrich Koehler, Jana Papassotiriou, Dimitrios T. Kremastinos, Waldemar Banasiak, Joachim Struck, Piotr Ponikowski, Andreas Bergmann, Stefan D. Anker

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Abstract

Objectives: Our aim was assess the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) using a new immunoassay in patients with chronic heart failure (HF). Background: Assessment of natriuretic peptides represents a useful addition in establishing the diagnosis of chronic HF. Their plasma values are powerful predictors of survival in chronic HF. Methods: We assessed MR-proANP in 525 chronic HF patients (derivation study: age 61 ± 12 years, New York Heart Association (NYHA) functional class I/II/III/IV 6%/44%/41%/9%, N-terminal pro-B-type natriuretic peptide (NT-proBNP) 3,637 ± 6,362 pg/ml) and validated our findings in 249 additional chronic HF patients (age 63 ± 9 years, NYHA functional class I/II/III/IV 14%/50%/33%/3%, NT-proBNP 1,116 ± 1,991 pg/ml). Results: The MR-proANP levels (mean 339 ± 306 pmol/l, range 24.5 to 2,280 pmol/l) increased with NYHA funcitonal class (p <0.0001). During follow-up (>6 months in survivors), 171 patients (33%) died. Increasing MR-proANP was a predictor of poor survival (risk ratio 1.35 per increase in standard deviation, 95% confidence interval 1.17 to 1.57; p = 0.0061), adjusted for NT-proBNP, age, left ventricular ejection fraction, NYHA functional class, creatinine, and body mass index (BMI). In receiver operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proANP was 0.74 and that of NT-proBNP was 0.75 (p = 0.7). In a validation study, MR-proANP levels above the optimal prognostic cutoff value from the validation cohort remained a significant independent predictor of death. In chronic HF patients in NYHA functional class II to III and all subgroups of BMI and kidney function, MR-proANP added prognostic value to NT-proBNP. In patients with BMI ≥30 kg/m2, MR-proANP had higher prognostic power than NT-proBNP. Conclusions: Midregional proANP is an independent predictor of mortality in patients with chronic HF. Midregional proANP adds prognostic information to NT-proBNP.

Original languageEnglish
Pages (from-to)1973-1980
Number of pages8
JournalJournal of the American College of Cardiology
Volume50
Issue number20
DOIs
Publication statusPublished - Nov 13 2007

ASJC Scopus subject areas

  • Nursing(all)

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    von Haehling, S., Jankowska, E. A., Morgenthaler, N. G., Vassanelli, C., Zanolla, L., Rozentryt, P., Filippatos, G. S., Doehner, W., Koehler, F., Papassotiriou, J., Kremastinos, D. T., Banasiak, W., Struck, J., Ponikowski, P., Bergmann, A., & Anker, S. D. (2007). Comparison of Midregional Pro-Atrial Natriuretic Peptide With N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Survival in Patients With Chronic Heart Failure. Journal of the American College of Cardiology, 50(20), 1973-1980. https://doi.org/10.1016/j.jacc.2007.08.012