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JACC Heart Fail. 2013 Jun;1(3):192-9. doi: 10.1016/j.jchf.2013.02.004. Epub 2013 Jun 3.

Atrial fibrillation impairs the diagnostic performance of cardiac natriuretic peptides in dyspneic patients: results from the BACH Study (Biomarkers in ACute Heart Failure).

Author information

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.

KEYWORDS:

atrial fibrillation; heart failure; natriuretic peptides

PMID:
24621869
DOI:
10.1016/j.jchf.2013.02.004
[Indexed for MEDLINE]
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