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Cardiac natriuretic peptides for diagnosis and risk stratification in heart failure: influences of left ventricular dysfunction and coronary artery disease on cardiac hormonal activation.

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Selvais, Philippe Ahn, Sylvia [UCL] Donckier, Julian [UCL] Robert, Annie [UCL] Laloux, O Vanlinden, François [UCL] Ketelslegers, Jean-Marie [UCL] Rousseau, Michel [UCL]

BACKGROUND: Cardiac natriuretic peptides are activated in heart failure. However, their diagnostic and prognostic values have not been compared under the routine conditions of an outpatient practice. METHODS: We studied the diagnostic and prognostic value of plasma N- and C-terminal peptides of the atrial natriuretic factor prohormone (N-proANF and ANF respectively) and brain natriuretic peptide (BNP) to evaluate the severity of congestive heart failure (CHF) as reflected by the New York Heart Association (NYHA) classification and to predict its 2-year mortality. Peripheral plasma concentrations of the three natriuretic peptides were measured in 27 normal subjects (CTR), in 32 patients with coronary artery disease (CAD) and normal left ventricular ejection fraction and in 101 patients with chronic CHF in functional classes I and II (n = 61) or III and IV (n = 40). RESULTS: Plasma concentrations of the three peptides increased in the presence of CHF in relation to its severity (P < 0.01). BNP was unable to distinguish CTR from CAD, just as ANF could not differentiate CAD from CHF I-II; only N-proANF displayed a significant and continuous increase from CTR to CAD, CHF I-II and III-IV. Receiver-operating characteristic curves showed better evaluation of the degree of CHF by BNP than by ANF or ejection fraction (P < 0.05). Assessment of the 2-year prognosis revealed that N-proANF and BNP were the best independent predictors of outcome after the NYHA classification. These peptides identify a very high-mortality group. CONCLUSION: Plasma N-proANF and BNP concentrations are good indicators of the severity and prognosis of CHF in an outpatient practice. CAD does not stimulate BNP as long as ventricular dysfunction is not present, although increased N-proANF levels in this setting suggest an early humoral activation.

Document type Article de périodique (Journal article) – Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
Publication date 1998
Journal information "European journal of clinical investigation" - Vol. 28, no. 8, p. 636-42 (1998)
Peer reviewed yes
issn 0014-2972
Publication status Publié
Affiliations UCL - MD/MINT - Département de médecine interne
UCL - MD/ESP - Ecole de santé publique
MESH Subject Aged ; Atrial Natriuretic Factor - blood ; Chronic Disease ; Coronary Disease - complications ; Female ; Heart Failure - diagnosis - etiology - mortality ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Outpatients ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Protein Precursors - blood ; Survival Analysis ; Ventricular Dysfunction, Left - complications
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Bibliographic reference Selvais, Philippe ; Ahn, Sylvia ; Donckier, Julian ; Robert, Annie ; Laloux, O ; et. al. Cardiac natriuretic peptides for diagnosis and risk stratification in heart failure: influences of left ventricular dysfunction and coronary artery disease on cardiac hormonal activation.. In: European journal of clinical investigation, Vol. 28, no. 8, p. 636-42 (1998)
Permanent URL http://hdl.handle.net/2078.1/13068