Elsevier

Journal of Cardiac Failure

Volume 6, Issue 3, September 2000, Pages 208-213
Journal of Cardiac Failure

Clinical Investigations
N-terminal proatrial natriuretic peptide and prognosis in patients with heart failure and preserved systolic function*,**

https://doi.org/10.1054/jcaf.2000.8836Get rights and content

Abstract

Background: Congestive heart failure and preserved left ventricular systolic function is a common clinical condition. Although the prognosis in this type of heart failure is better in comparison to systolic dysfunction, prognostic markers to evaluate long-term outcome are lacking. The atrial peptide, N-terminal proatrial natriuretic peptide (proANP), has been shown to predict survival in patients with systolic dysfunction. We intended to evaluate the predictive capability of N-terminal proANP in patients with preserved systolic function (ejection fraction [EF] ≥ 0.40). Methods and Results: A clinical and echocardiographic examination was performed in 149 patients with idiopathic heart failure from a population-based cohort, and 84 patients were identified to have preserved systolic function, with an EF of 0.40 or greater. The patients were followed up during 7 years with regard to symptoms, treatment, hospitalization, and survival. The patients with normal EFs had greater plasma concentrations of N-terminal proANP compared with a control group, and N-terminal proANP level was an independent predictor of mortality (risk ratio, 2.44; 95% confidence interval, 1.28 to 4.67; P =.007). In addition, a high concentration of N-terminal proANP predicted an increased rate of hospitalization (50% for a level >1,200 pmol/L versus 19% for a level ≤1,200 pmol/L; P =.046) and a greater future dosage of diuretic (127 ± 102 vs 51 ± 39 mg; P =.007). Conclusion: N-terminal proANP level was an independent marker of increased mortality and morbidity in patients with preserved systolic function, whereas EF was not usable in this regard. It is suggested that this peptide could be used to identify clinically relevant left ventricular dysfunction in patients with EFs within the normal range.

Section snippets

Patients

The patients studied were selected from an epidemilogical survey of idiopathic congestive heart failure undertaken in 5 counties in southwest Sweden between 1985 and 1988 (13). All hospital records of the 19 hospitals serving the studied region were screened, and patients with a registered diagnosis of congestive heart failure between 1980 and 1987 were identified. Besides a diagnosis of heart failure in the hospital record, one of the following recorded findings was required for inclusion on

Results

A technically satisfactory echocardiogram and a blood sample for analysis of N-terminal proANP level were available in 149 of the 293 patients. Among these, 65 patients were diagnosed as having systolic dysfunction (EF < 0.40). Of the remaining 84 patients, 60 patients had at least 1 sign of compromised cardiac function (abnormal-echo group). Twenty-one patients had echocardiographic data within normal limits (normal-echo group). Three patients could not be accurately classified regarding other

Discussion

Previous studies have shown that plasma concentration of N-terminal proANP is related to long-term prognosis in patients with chronic heart failure 11, 12. The present results confirm these findings in a cohort of patients selected for the diagnosis of idiopathic congestive heart failure. Idiopathic congestive heart failure accounts for 20% to 25% of the clinical heart failure population (20), and our results may be valid only for this group of patients with heart failure. The possibility of

Conclusion

An increased concentration of N-terminal proANP might be a marker of future morbidity and death in patients with normal EFs, and this peptide was an independent predictor of long-term mortality among these patients. This simple blood test might be useful in the difficult assessment of patients with congestive heart failure symptoms and preserved systolic function.

Acknowledgements

The authors thank Ellen Lund Sagen and Hanne Schulz Jensen for performing the immunoassays, and Thomas Karlsson, BSc, for the statistical analyses.

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*

Supported in part by the Swedish Heart Lung Foundation, Stockholm, Sweden.

**

Reprint requests: Bert Andersson, MD, PhD, Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

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