Abstract 13881: Determining Factors and Prognostic Value of Plasma γ- Atrial Natriuretic Peptide Ratio in Patients With Heart Failure

Abstract

Background: Atrial natriuretic peptide (ANP) is a peptide hormone that maintain sodium homeostasis and inhibit activation of the renin-angiotensin-aldosterone system. Three endogenous molecular forms of human ANP, including fully bioactive α-ANP, β-ANP; an antiparallel dimer of α-ANP, and γ-ANP; α-ANP precursor, are present in heart and plasma of patients with heart failure (HF). However, the clinical importance of molecular ratio of ANP has not been evaluated. This study was designed to evaluate plasma γ-ANP and total amount of ANP levels (total ANP) in patients HF, and identify the determining factor and prognostic value of %γ-ANP (γ-ANP /total ANP ratio). Method and Results: We prospectively evaluated plasma γ-ANP and total ANP levels in 148 patients with acute decompensated HF before discharge using by chemiluminescence enzyme immunoassay. Median plasma total ANP and γ-ANP levels were 142.5 [63.2-231.3] and 10.9 [4.4-25.6] pmol/ml, respectively. %γ-ANP was 8.9 [5.5-15.2]% and significantly correlated with age (ρ=0.205; p=0.01), body mass index (BMI) (ρ=-0.316; p<0.001), left ventricular ejection fraction (LVEF) (ρ=-0.250; p=0.002), hemoglobin (ρ=-0.182; p=0.03), and B-type natriuretic peptide (BNP) levels (ρ=0.393; p<0.002). Patients with high %γ-ANP (≥ median value) were more likely to have ischemic etiology and prior HF hospitalization history. High %γ-ANP tended to increase all cause death (p=0.06) and was significantly associated with repeat HF-related hospitalization (p=0.01; Figure ). Conclusion: Increase of %γ-ANP was associated with older age, lower BMI, LVEF hemoglobin, and higher BNP levels. High %γ-ANP was a predictor of future HF-related rehospitalization. These results suggested that %γ-ANP was affected by presence of known poor prognostic factors of HF.