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Comparative Study
. 2011 Dec;86(12):1154-60.
doi: 10.4065/mcp.2011.0437.

Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study

Paul M McKie  1 , Alessandro Cataliotti, S Jeson Sangaralingham, Tomoko Ichiki, Valentina Cannone, Kent R Bailey, Margaret M Redfield, Richard J Rodeheffer, John C Burnett Jr
Affiliations
Comparative Study

Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study

Paul M McKie et al. Mayo Clin Proc. 2011 Dec.

Abstract

Objective: To determine the predictive value of atrial natriuretic peptide (ANP), N-terminal pro-ANP (NT-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for mortality and cardiovascular events in the general population in the absence of overt heart failure (HF).

Participants and methods: We identified a community-based cohort of 2042 individuals. Those with stage C or D HF (n=45) and renal insufficiency (n=6) were excluded from the current study. Of the remaining individuals, 1769 (89%) underwent echocardiography and measurement of plasma ANP, NT-proANP, and NT-proBNP. Participants were followed up from January 1, 1997, to May 1, 2009, for mortality, HF, myocardial infarction (MI), and cerebrovascular accident; median follow-up was 9 years.

Results: After adjustment for conventional clinical risk factors, NT-proANP had significant predictive value for mortality but not for HF, MI, or cerebrovascular accident, whereas ANP lacked any predictive value. The predictive value of NT-proANP for mortality was attenuated after adjustment for structural and functional cardiac abnormalities. In contrast, NT-proBNP had predictive value for mortality, HF, and MI after adjustment for conventional risk factors and retained significance for mortality and HF after adjustment for structural and functional cardiac abnormalities.

Conclusion: Our results suggest that NT-proBNP is a more robust cardiac biomarker compared with ANP or NT-proANP and is independently predictive of mortality and HF in the general population free of overt HF.

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Figures

FIGURE 1.
FIGURE 1.
Kaplan-Meier curves for mortality in the sample population according to age- and sex-specific tertiles of N-terminal pro-atrial natriuretic peptide (NT-proANP) (A), atrial natriuretic peptide (ANP) (B), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (C). Age- and sex-specific tertile values of NT-proANP, ANP, and NT-proBNP are shown in Table 2. P value is for trend across the tertiles.
FIGURE 2.
FIGURE 2.
Kaplan-Meier curves for heart failure in the sample population according to age- and sex-specific tertiles of N-terminal pro-atrial natriuretic peptide (NT-proANP) (A), atrial natriuretic peptide (ANP) (B), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (C). Age- and sex-specific tertile values of NT-proANP, ANP, and NT-proBNP are shown in Table 2. P value is for trend across the tertiles.
FIGURE 3.
FIGURE 3.
Hazard ratios for N-terminal pro-atrial natriuretic peptide (NT-proANP) (A) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (B) for mortality, heart failure, myocardial infarction, and cerebrovascular accident. Multivariable model 1 is adjusted for age, sex, body mass index, total cholesterol, serum creatinine, presence of diabetes mellitus, hypertension, and coronary artery disease. In panel A, NT-proBNP is added to multivariable model 1, and in panel B, NT-proANP is added to multivariable model 1. Data are presented as hazard ratios with 95% confidence intervals (CIs).
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Comment in

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