Mark Richards1, Salvatore Di Somma2, Christian Mueller3, Richard Nowak4, W Frank Peacock5, Piotr Ponikowski6, Martin Mockel7, Christopher Hogan8, Alan H B Wu9, Paul Clopton10, Gerasimos S Filippatos11, Inder Anand12, Leong Ng13, Lori B Daniels14, Sean-Xavier Neath15, Kevin Shah16, Robert Christenson15, Oliver Hartmann17, Stefan D Anker18, Alan Maisel14. 1. University of Otago, Christchurch, New Zealand; National University Heart Centre, Singapore. Electronic address: Mark.Richards@cdhb.health.nz. 2. Sant'Andrea Hospital, University La Sapienza, Rome, Italy. 3. University Hospital Basel, Basel, Switzerland. 4. Henry Ford Health System, Detroit, Michigan. 5. The Cleveland Clinic, Cleveland, Ohio. 6. Medical University, Faculty of Public Health, Wroclaw, Poland. 7. Charite, Campus Virchow-Klinikum, Berlin, Germany. 8. Virginia Commonwealth University, Richmond, Virginia. 9. University of California San Francisco, California. 10. Veterans' Administration San Diego Healthcare System, San Diego, California. 11. Athens University Hospital Attikon, Athens, Greece. 12. Veterans' Administration Minneapolis, Minnesota. 13. University of Leicester, Leicester, United Kingdom. 14. University of California San Diego, California. 15. University of Maryland, Baltimore, Maryland. 16. Sant'Andrea Hospital, University La Sapienza, Rome, Italy; Veterans' Administration San Diego Healthcare System, San Diego, California. 17. BRAHMS Aktiengesellschaft Biotechnology Centre Hennigsdorf, Berlin, Germany. 18. Charite, Campus Virchow-Klinikum, Berlin, Germany; Centre for Clinical and Basic Research IRCCS, San Raffaele, Roma, Italy.
Abstract
OBJECTIVES: The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients. BACKGROUND: The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported. METHODS: A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF. RESULTS: AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality. CONCLUSIONS: AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.
OBJECTIVES: The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients. BACKGROUND: The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported. METHODS: A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF. RESULTS:AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality. CONCLUSIONS:AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.
Authors: Stephen J Greene; Gregg C Fonarow; Scott D Solomon; Haris P Subacius; Andrew P Ambrosy; Muthiah Vaduganathan; Aldo P Maggioni; Michael Böhm; Eldrin F Lewis; Faiez Zannad; Javed Butler; Mihai Gheorghiade Journal: Eur J Heart Fail Date: 2016-10-17 Impact factor: 15.534
Authors: Saima Hilal; Yuek Ling Chai; Susanne van Veluw; Muhammad Amin Shaik; Mohammad Kamran Ikram; Narayanaswamy Venketasubramanian; Arthur Mark Richards; Geert Jan Biessels; Christopher Chen Journal: JAMA Neurol Date: 2017-04-01 Impact factor: 18.302
Authors: Amir Y Shaikh; Nada Esa; William Martin-Doyle; Menhel Kinno; Iryna Nieto; Kevin C Floyd; Clifford Browning; Cynthia Ennis; J Kevin Donahue; Lawrence S Rosenthal; David D McManus Journal: Crit Pathw Cardiol Date: 2015-12