Circulation, Vol 89, 1934-1942, Copyright © 1994 by American Heart Association
C Hall, JL Rouleau, L Moye, J de Champlain, D Bichet, M Klein, B Sussex, M Packer, J Rouleau and MO Arnold
BACKGROUND: Atrial natriuretic factor (ANF) is a peptide hormone secreted
from cardiac atria in response to increased atrial pressure. Because of a
longer half-life and greater stability, the N-terminal of ANF prohormone
(N-terminal proANF) may be a better integrator of atrial peptide secretion
than ANF itself. After myocardial infarction, elevation of ANF and other
neurohormones has been associated with a poor prognosis. However, when left
ventricular ejection fraction (LVEF) and other important clinical variables
are included in multivariate analysis, the independent predictive value of
these neurohormones has been reduced markedly. METHODS AND RESULTS: To test
the prognostic value of N-terminal proANF after myocardial infarction, its
plasma concentration was measured a mean of 12 days after infarction in 246
patients in the Survival and Ventricular Enlargement (SAVE) Study. N-
terminal proANF was a much stronger predictor of survival than ANF itself.
Furthermore, in multivariate analysis of cardiovascular mortality and
development of heart failure, N-terminal proANF in contrast to ANF and
other neurohormones was still a powerful and independent predictor when the
model included age, gender, prior myocardial infarction, hypertension,
diabetes, use of thrombolysis, Killip class, infarct location, and LVEF.
CONCLUSIONS: The measurement of N-terminal proANF supplements presently
used clinical and objective assessments and provides an important
independent predictor of prognosis with respect to cardiovascular mortality
and development of heart failure.
ARTICLES
N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction
Institute for Surgical Research, University of Oslo, Norway.
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