Midregional pro-A-type Natriuretic Peptide Research Articles

Midregional pro-A-type natriuretic peptide for the evaluation of exercise intolerance

The aim of this study was to determine the accuracy of midregional pro-A-type natriuretic peptide (MR-proANP) for the identification of a cardiocirculatory exercise limitation (CL) as assessed by cardiopulmonary exercise testing (CPET) and to compare it to B-type natriuretic peptide (BNP). Among 94 patients with CPET data fulfilling criteria for appropriate effort and sufficient diagnostic certainty, 27 (29%) had CL. The areas under the receiver-operator-characteristic curve for MR-proANP and BNP to identify CL were 0.84 and 0.79 respectively (p=0.17). In conclusion, MR-proANP had a comparable accuracy to BNP for the identification of CL and might be a valuable assistance for the differentiation of exercise intolerance.

Comparative Evaluation of B-Type Natriuretic Peptide, Mid-Regional Pro-A-type Natriuretic Peptide, Mid-Regional Pro-Adrenomedullin, and Copeptin to Predict 1-Year Mortality in Patients With Acute Destabilized Heart Failure

The aim of the present study was to evaluate the capability B-type natriuretic peptide (BNP) as a prognostic marker in patients with acute destabilized heart failure in comparison with mid-regional pro-A-type natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin (MR-proADM), and the C-terminal part of the arginine vasopressin prohormone (Copeptin). BNP, MR-proANP, MR-proADM, and Copeptin plasma concentrations were obtained in 137 patients with acute destabilized heart failure attending a tertiary care hospital. The end point was defined as all-cause mortality, and the study participants were followed for 365 days. Of the 137 patients enrolled, 41 died and 96 survived during follow-up. ROC curve analysis showed that the areas under curve for the prediction of 1-year mortality were similar for BNP (0.716; 95% CI 0.633-0.790), MR-proANP (0.725; 95% CI 0.642-0.798), MR-proADM (0.708; 95% CI 0.624-0.782), and Copeptin (0.688; 95% CI 0.603-0.764). Using tercile approaches, Kaplan-Meier curve analyses demonstrated that the predictive value of all four analytes for survival probability was comparable (log-rank test for trend, P < .001 for each). In multivariable Cox proportional-hazards regression analyses, increased BNP, MR-proANP, MR-proADM, and Copeptin plasma concentrations were the strongest predictors of mortality. BNP is considered an established prognostic marker for heart failure patients. The present study provides evidence that MR-proANP, MR-proADM, and Copeptin measurements might have similar predictive properties compared with BNP determinations for one-year all-cause mortality in acute destabilized heart failure.