National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore.
Yong Loo Lin School of Medicine, National University Singapore, Singapore.
JACC Heart Fail. 2024 Mar;12(3):461-474. doi: 10.1016/j.jchf.2023.09.011. Epub 2023 Oct 25.
Natriuretic peptide (NP) elevations are prognostic in heart failure (HF), but relative atrial NP deficiency in acute HF has been suggested.
The authors compared plasma concentrations and relative strength of associations of A- and B-type NPs with cardiac structure/function and clinical outcomes in HF.
Midregional pro-atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured in patients with compensated HF in a prospective, multicenter study. The primary outcome was a composite of HF-hospitalization or all-cause mortality. Secondary outcomes included individual primary outcome components and cardiovascular admission.
Among 1,278 patients (age 60.1 ± 12.1 years, 82% men, left ventricular ejection fraction [LVEF] 34% ± 14%), median concentrations of MR-proANP were 990 pg/mL (Q1-Q3: 557-1,563 pg/mL), NT-proBNP 1,648 pg/mL (Q1-Q3: 652-3,960 pg/mL), and BNP 291 pg/mL (Q1-Q3: 103-777 pg/mL). No subpopulation with inappropriately low MR-proANP (relative to BNP/NT-proBNP) was observed. Clinical event rates were similar for biomarker tertiles. Increments in MR-proANP exhibited steeper associations with concurrent shifts in left ventricular size, diastolic indexes and LVEF than BNP/NT-proBNP at baseline and serially (P < 0.05), and lower odds of beneficial left ventricular reverse remodeling: OR: 0.35 (95% CI: 0.18-0.70). In single-biomarker models, MR-proANP(log) was associated with the highest hazard (4 to 6 times) for each outcome. In multimarker models, independent associations were observed for the primary outcome (MR-proANP and NT-proBNP), HF-hospitalization and cardiovascular admission (MR-proANP only), and all-cause mortality (NT-proBNP only) (P < 0.05). The discriminative value of MR-proANP was superior to BNP/NT-proBNP (HF-hospitalization) and BNP (primary outcome) (P < 0.05).
MR-proANP was not inappropriately low relative to concurrent BNP/NT-proBNP values. Proportional increments in MR-proANP were more pronounced than for B-peptides for given decrements in cardiac structure/function. MR-proANP offered greater independent predictive power overall.
利钠肽（NP）升高对心力衰竭（HF）具有预后价值，但急性 HF 中相对心房 NP 缺乏已被提出。
作者比较了 A 型和 B 型 NP 与 HF 患者心脏结构/功能和临床结局的血浆浓度和相关性。
前瞻性、多中心研究中测量了代偿性 HF 患者的中段 pro-心房利钠肽（MR-proANP）、B 型利钠肽（BNP）和 N 末端 pro-B 型利钠肽（NT-proBNP）。主要结局是 HF 住院或全因死亡率的复合结局。次要结局包括单一主要结局组成部分和心血管入院。
在 1278 例患者（年龄 60.1 ± 12.1 岁，82%为男性，左心室射血分数[LVEF]为 34% ± 14%）中，MR-proANP 的中位数浓度为 990 pg/mL（Q1-Q3：557-1563 pg/mL），NT-proBNP 为 1648 pg/mL（Q1-Q3：652-3960 pg/mL），BNP 为 291 pg/mL（Q1-Q3：103-777 pg/mL）。未观察到任何亚群的 MR-proANP（相对于 BNP/NT-proBNP）相对过低。生物标志物三分位组的临床事件发生率相似。与 BNP/NT-proBNP 相比，MR-proANP 的增量与左心室大小、舒张指数和 LVEF 的同时变化具有更陡峭的相关性，在基线和连续（P<0.05）时具有较低的左心室逆重构的优势，OR：0.35（95%CI：0.18-0.70）。在单生物标志物模型中，MR-proANP（log）与每种结局的最高风险（4 至 6 倍）相关。在多标志物模型中，主要结局（MR-proANP 和 NT-proBNP）、HF 住院和心血管入院（仅 MR-proANP）以及全因死亡率（仅 NT-proBNP）均观察到独立的相关性（P<0.05）。MR-proANP 的判别价值优于 BNP/NT-proBNP（HF 住院）和 BNP（主要结局）（P<0.05）。
MR-proANP 相对于同期 BNP/NT-proBNP 值并不过低。MR-proANP 的比例增加比 B 肽更明显，而心脏结构/功能的下降幅度相同。MR-proANP 提供了更大的独立预测能力。
