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Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea.
Eur Heart J. 2012 Sep; 33(17):2197-205.EH

Abstract

AIMS

The aim of this study was to assess diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP) and adrenomedullin (MR-proADM) for the evaluation of patients presenting to the emergency department with acute dyspnoea.

METHODS AND RESULTS

A total of 560 patients from the pro-B type natriuretic peptide Investigation of Dyspnoea in the Emergency Department were evaluated; 180 had acutely decompensated heart failure (ADHF). Concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), MR-proADM, and MR-proANP were measured, and patients were followed to 4 years for survival. Logistic regression evaluated utility of MR-proANP in ADHF diagnosis. Area under the curve (AUC), multivariate Cox regression, net reclassification improvement, and Kaplan-Meier survival analyses were used for mortality analyses. Mid-regional pro-atrial natriuretic peptide was higher in patients with ADHF (median 329 vs. 58 pmol/L; P < 0.001), and remained an independent predictor of HF diagnosis even when NT-proBNP was included as a covariate (odds ratio = 4.34, 95% CI = 2.11-8.92; P < 0.001). In time-dependent analyses, MR-proADM had the highest AUC for death during the first year; after 1 year, MR-proANP and NT-proBNP had a higher AUC. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan-Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy.

CONCLUSION

Among patients with acute dyspnoea, MR-proANP is accurate for diagnosis of ADHF, while both MR-proANP and MR-proADM are independently prognostic to 4 years of the follow-up.

Authors+Show Affiliations

Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 32 Fruit Street, Boston, MA 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22645194

Citation

Shah, Ravi V., et al. "Mid-regional Pro-atrial Natriuretic Peptide and Pro-adrenomedullin Testing for the Diagnostic and Prognostic Evaluation of Patients With Acute Dyspnoea." European Heart Journal, vol. 33, no. 17, 2012, pp. 2197-205.
Shah RV, Truong QA, Gaggin HK, et al. Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. Eur Heart J. 2012;33(17):2197-205.
Shah, R. V., Truong, Q. A., Gaggin, H. K., Pfannkuche, J., Hartmann, O., & Januzzi, J. L. (2012). Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. European Heart Journal, 33(17), 2197-205. https://doi.org/10.1093/eurheartj/ehs136
Shah RV, et al. Mid-regional Pro-atrial Natriuretic Peptide and Pro-adrenomedullin Testing for the Diagnostic and Prognostic Evaluation of Patients With Acute Dyspnoea. Eur Heart J. 2012;33(17):2197-205. PubMed PMID: 22645194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea. AU - Shah,Ravi V, AU - Truong,Quynh A, AU - Gaggin,Hanna K, AU - Pfannkuche,Jens, AU - Hartmann,Oliver, AU - Januzzi,James L,Jr Y1 - 2012/05/29/ PY - 2012/5/31/entrez PY - 2012/5/31/pubmed PY - 2013/1/1/medline SP - 2197 EP - 205 JF - European heart journal JO - Eur Heart J VL - 33 IS - 17 N2 - AIMS: The aim of this study was to assess diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP) and adrenomedullin (MR-proADM) for the evaluation of patients presenting to the emergency department with acute dyspnoea. METHODS AND RESULTS: A total of 560 patients from the pro-B type natriuretic peptide Investigation of Dyspnoea in the Emergency Department were evaluated; 180 had acutely decompensated heart failure (ADHF). Concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), MR-proADM, and MR-proANP were measured, and patients were followed to 4 years for survival. Logistic regression evaluated utility of MR-proANP in ADHF diagnosis. Area under the curve (AUC), multivariate Cox regression, net reclassification improvement, and Kaplan-Meier survival analyses were used for mortality analyses. Mid-regional pro-atrial natriuretic peptide was higher in patients with ADHF (median 329 vs. 58 pmol/L; P < 0.001), and remained an independent predictor of HF diagnosis even when NT-proBNP was included as a covariate (odds ratio = 4.34, 95% CI = 2.11-8.92; P < 0.001). In time-dependent analyses, MR-proADM had the highest AUC for death during the first year; after 1 year, MR-proANP and NT-proBNP had a higher AUC. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan-Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy. CONCLUSION: Among patients with acute dyspnoea, MR-proANP is accurate for diagnosis of ADHF, while both MR-proANP and MR-proADM are independently prognostic to 4 years of the follow-up. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/22645194/Mid_regional_pro_atrial_natriuretic_peptide_and_pro_adrenomedullin_testing_for_the_diagnostic_and_prognostic_evaluation_of_patients_with_acute_dyspnoea_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehs136 DB - PRIME DP - Unbound Medicine ER -