Abstract 12613: Comparison of the Predictive Utility of Atrial, N-Terminal Pro-Atrial, and N-Terminal Pro-B-Type Natriuretic Peptides for Death and Cardiovascular Events: Superiority of N-Terminal Pro-B-Type Natriuretic Peptide
Background: BNP and especially NT-proBNP have prognostic value for death and cardiovascular (CV) morbidity. ANP, like BNP, is a hormone released in response to myocardial stimuli. Few studies evaluate the prognostic value of ANP and N-terminal ANP (NT-ANP).
Hypothesis: ANP and NT-ANP will have significant prognostic value for death and CV morbidity in the general population. NT-ANP and NT-proBNP will be superior biomarkers due to reduced degradation.
Methods: We identified a community-based cohort of 2,042 subjects in Olmsted Co, MN. Subjects with Stage C / D heart failure (HF) were excluded. The remaining 1,991 subjects underwent echocardiography and ANP, NT-ANP, and NT-proBNP measurement. Subjects were followed for death, HF, cerebrovascular accident (CVA), and myocardial infarction (MI). Median follow up was 8.9 yrs. Hazard ratios (HR) for ANP, NT-ANP, and NT-proBNP >80th percentile were calculated. Statistical significance: p<0.05.
Results: Age, gender, and BMI adjusted (model 1) HRs demonstrate NT-ANP and NT-proBNP have prognostic significance for death, HF, MI, and CVA (HRs 1.57, 1.91, 1.59, and 1.12 for NT-ANP respectively and 2.34, 3.65, 2.90, and 1.50 for NT-proBNP respectively) whereas ANP lacks signficance in model 1. In model 2 we added cholesterol, creatinine, and presence of diabetes, hypertension, and coronary artery disease to model 1. In model 2, NT-ANP lost prognostic significance for all outcomes except HF (HR 1.73) whereas NT-proBNP retained prognostic significance for death, HF, MI, and CVA (HRs 1.90, 3.04, 2.13, and 1.34 respectively). In model 3 EF < 50%, diastolic dysfunction, valvular dysfunction, left ventricular hypertrophy, and left atrial enlargement were added to model 2. In model 3, NT-proBNP retained prognostic significance for death, HF, and MI (HRs 1.90, 2.05, and 1.93 respectively).
Conclusions: Plasma NT-ANP and NT-proBNP have prognostic significance for death and CV morbidity in the general population in the absence of HF. However, NT-proBNP is a more robust biomarker than NT-ANP, and NT-proBNP provides significant prognostic utility beyond clinical and echocardiographic assessment. These findings have important implications as prospective prevention trials are aimed at individuals with increased CV risk.
- © 2010 by American Heart Association, Inc.