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Pro-A-type natriuretic peptide, proadrenomedullin, and N-terminal pro-B-type natriuretic peptide used in a multimarker strategy in primary health care in risk assessment of patients with symptoms of heart failure.
J Card Fail. 2013 Jan; 19(1):31-9.JC

Abstract

OBJECTIVE

Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care.

METHODS AND RESULTS

The study included 470 elderly patients (mean age 73 years) with symptoms of heart failure in primary health care. All participants underwent clinical examination, 2-dimenstional echocardiography, and plasma measurement of the 3 propeptides and were followed for 13 years. All mortality was registered during the follow-up period. The 4th quartiles of the biomarkers were applied as cutoff values. NT-proBNP exhibited the strongest prognostic information with >4-fold increased risk for cardiovascular mortality within 5 years. For all-cause mortality MR-proADM exhibited almost 2-fold and NT-proBNP 3-fold increased risk within 5 years. In the 5-13-year perspective, NT-proBNP and MR-proANP showed significant and independent cardiovascular prognostic information. NT-proBNP and MR-proADM showed significant prognostic information regarding all-cause mortality during the same time. In those with ejection fraction (EF) <40%, MR-proADM exhibited almost 5-fold increased risk of cardiovascular mortality with 5 years, whereas in those with EF >50% NT-proBNP exhibited >3-fold increased risk if analyzed as the only biomarker in the model. If instead the biomarkers were all below the cutoff value, the patients had a highly reduced mortality risk, which also could influence the handling of patients.

CONCLUSIONS

The 3 biomarkers could be integrated in a multimarker strategy for use in primary health care.

Authors+Show Affiliations

Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology, University Hospital of Linköping, County Council of Östergötland, Linköping, Sweden. urban.alehagen@liu.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23273592

Citation

Alehagen, Urban, et al. "Pro-A-type Natriuretic Peptide, Proadrenomedullin, and N-terminal pro-B-type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure." Journal of Cardiac Failure, vol. 19, no. 1, 2013, pp. 31-9.
Alehagen U, Dahlström U, Rehfeld JF, et al. Pro-A-type natriuretic peptide, proadrenomedullin, and N-terminal pro-B-type natriuretic peptide used in a multimarker strategy in primary health care in risk assessment of patients with symptoms of heart failure. J Card Fail. 2013;19(1):31-9.
Alehagen, U., Dahlström, U., Rehfeld, J. F., & Goetze, J. P. (2013). Pro-A-type natriuretic peptide, proadrenomedullin, and N-terminal pro-B-type natriuretic peptide used in a multimarker strategy in primary health care in risk assessment of patients with symptoms of heart failure. Journal of Cardiac Failure, 19(1), 31-9. https://doi.org/10.1016/j.cardfail.2012.11.002
Alehagen U, et al. Pro-A-type Natriuretic Peptide, Proadrenomedullin, and N-terminal pro-B-type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure. J Card Fail. 2013;19(1):31-9. PubMed PMID: 23273592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pro-A-type natriuretic peptide, proadrenomedullin, and N-terminal pro-B-type natriuretic peptide used in a multimarker strategy in primary health care in risk assessment of patients with symptoms of heart failure. AU - Alehagen,Urban, AU - Dahlström,Ulf, AU - Rehfeld,Jens F, AU - Goetze,Jens P, PY - 2012/08/29/received PY - 2012/10/29/revised PY - 2012/11/08/accepted PY - 2013/1/1/entrez PY - 2013/1/1/pubmed PY - 2013/6/1/medline SP - 31 EP - 9 JF - Journal of cardiac failure JO - J Card Fail VL - 19 IS - 1 N2 - OBJECTIVE: Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care. METHODS AND RESULTS: The study included 470 elderly patients (mean age 73 years) with symptoms of heart failure in primary health care. All participants underwent clinical examination, 2-dimenstional echocardiography, and plasma measurement of the 3 propeptides and were followed for 13 years. All mortality was registered during the follow-up period. The 4th quartiles of the biomarkers were applied as cutoff values. NT-proBNP exhibited the strongest prognostic information with >4-fold increased risk for cardiovascular mortality within 5 years. For all-cause mortality MR-proADM exhibited almost 2-fold and NT-proBNP 3-fold increased risk within 5 years. In the 5-13-year perspective, NT-proBNP and MR-proANP showed significant and independent cardiovascular prognostic information. NT-proBNP and MR-proADM showed significant prognostic information regarding all-cause mortality during the same time. In those with ejection fraction (EF) <40%, MR-proADM exhibited almost 5-fold increased risk of cardiovascular mortality with 5 years, whereas in those with EF >50% NT-proBNP exhibited >3-fold increased risk if analyzed as the only biomarker in the model. If instead the biomarkers were all below the cutoff value, the patients had a highly reduced mortality risk, which also could influence the handling of patients. CONCLUSIONS: The 3 biomarkers could be integrated in a multimarker strategy for use in primary health care. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/23273592/Pro_A_type_natriuretic_peptide_proadrenomedullin_and_N_terminal_pro_B_type_natriuretic_peptide_used_in_a_multimarker_strategy_in_primary_health_care_in_risk_assessment_of_patients_with_symptoms_of_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1071-9164(12)01333-4 DB - PRIME DP - Unbound Medicine ER -