Author + information
- Received October 2, 2012
- Revision received February 22, 2013
- Accepted February 25, 2013
- Published online June 1, 2013.
- Mark Richards, MD, PhD∗,†∗ (, )
- Salvatore Di Somma, MD‡,
- Christian Mueller, MD§,
- Richard Nowak, MD‖,
- W. Frank Peacock, MD¶,
- Piotr Ponikowski, MD, PhD#,
- Martin Mockel, MD∗∗,
- Christopher Hogan, MD††,
- Alan H.B. Wu, PhD‡‡,
- Paul Clopton, MS§§,
- Gerasimos S. Filippatos, MD‖‖,
- Inder Anand, MD, DPhil(Oxon)¶¶,
- Leong Ng, MD##,
- Lori B. Daniels, MD, MAS∗∗∗,
- Sean-Xavier Neath, MD, PhD†††,
- Kevin Shah, BS‡,§§,
- Robert Christenson, PhD†††,
- Oliver Hartmann, MSc‡‡‡,
- Stefan D. Anker, MD, PhD∗∗,§§§ and
- Alan Maisel, MD∗∗∗
- ↵∗Reprint requests and correspondence:
Dr. Mark Richards, University of Otago, Cardioendocrine Research Group, Christchurch School of Medicine and Health Sciences, P O Box 4345, Christchurch, Christchurch NA, New Zealand.
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.
Dr. Richards is on the Scientific Advisory Board of Alere; and has received travel support, honoraria, and research grants from Roche Diagnostics and Alere. Dr Maisel has received research support from Roche, Biosite, and Bayer; and is a consultant to Alere. Dr. Mueller has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Novartis Foundation, the Krokus Foundation, Abbott, Biosite, BRAHMS, Roche, and the University of Basel. Dr. Peacock is on the scientific advisory boards of Abbott, Beckman-Coulter, Alere, Ortho Clinical Diagnostics, and Response Biomedical; and has received research grants from Abbott and Alere. Dr. Ponikowski has received honoraria for serving as a consultant for Vifor and Athera; and as a speaker for Merck-Serono, Pfizer, and Sanofi-Aventis. Dr. Filippatos has received research support from Alere, BRAHMS, and Roche. Dr. DiSomma is a consultant to Alere. Dr. Ng is a consultant for Alere and BRAHMS AG. Dr. Daniels has received research support from Alere and Roche Diagnostics. Dr. Neath is a consultant to BRAHMS USA. Dr. Christensen is a consultant for Siemens, BG-Medicine, Critical Care Diagnostics, Alere, and Abbott Diagnostics; and has received research support from Siemens, BG-Medicine, BRAHMS, Roche, Alere, and Nanosphere. Dr. McCord has received research funding from BRAHMS Diagnostics. Mr. Hartmann is an employee of BRAHMS AG, which markets the MR-proANP and MR-proADM assays used in this study. Dr. Anker has received research support from BRAHMS; honoraria from Abbott and Alere; and is a consultant to BRAHMS.
- Received October 2, 2012.
- Revision received February 22, 2013.
- Accepted February 25, 2013.
- American College of Cardiology Foundation