- 作者：Marie-France Seronde ; Etienne Gayat ; Damien Logeart ; Johan Lassus ; Said Laribi ; Riadh Boukef ; Franck Sibellas ; Jean-Marie Launay ; Philippe Manivet ; Malha Sadoune ; Semir Nouira ; Alain Cohen Solal ; Alex ; re Mebazaa
- 关键词：Prognosis ; Diagnosis ; B-type natriuretic peptides ; Atrial-type natriuretic peptides ; Acute heart failure
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：9 October, 2013
- 年：2013
- 卷：168
- 期：4
- 页码：3404-3411
- 全文大小：866 K
Background
We compared diagnostic and prognostic properties of brain natruiretic peptide (BNP), proBNP, NT-proBNP and MR-pro-atrial natriuretic peptide (ANP) in patients admitted with shortness of breath (SOB).Methods
All 4 NPs were measured in patients admitted to the emergency unit with SOB (in 2 centers) or acute heart failure (AHF) (1 FINN-AKVA cohort) and in a control population of stable chronic HF. Follow-up was 1 (2 centers) and 5 years (1 FINN-AKVA cohort). Area under the curve (AUC) was used to assess diagnostic properties. AUC, multivariate Cox regression, net reclassification improvement (NRI), and Kaplan-Meier analyses were used to assess mortality.
Results
We included 710 patients (¡°Biomarcoeurs¡± cohort n = 336; FINN-AKVA study, n = 306; stable chronic HF, n = 68). Pro-BNP was almost as powerful as BNP to diagnose AHF (AUC 0.953 vs 0.973 respectively, p = 0.003), NT-proBNP also performed well (0.922, p < 0.001 vs BNP). MR-proANP performed less well (0.901). AUC over time showed greater MR-proANP values over the first year. At 5 years, MR-proANP had the best prognostic value (AUC 0.668 vs 0.604 for BNP, p = 0.042). Kaplan Meier analysis confirmed better survival with MR-proANP ¡Ü 416.8 pmol/L at 5 years. NRI at 5 years was greater for MR-proANP (0.23, p < 0.05) than for proBNP, BNP or NTproBNP (p = NS).
Conclusion
Our study provides firm evidence that all NPs perform equally well for diagnostic purposes, and that MR-proANP has long term prognostic value in patients with acute heart failure.