N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction.

Abstract

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.

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

“…In patients with the suspicion of heart failure several other studies showed natriuretic peptides to be useful indicators for the detection of heart failure (Lerman et al, 1993;Davidson et al, 1996;Cowie et al, 1997;Hammerer-Lercher et al, 2001;Maisel et al, 2002Maisel et al, , 2003. In the follow-up of patients with an acute cardiac event levels of natriuretic peptides were proved to be of prognostic value for outcome (Hall et al, 1994;Omland et al, 1996;de Lemos et al, 2001;Koglin et al, 2001;Richards et al, 2003).…”

Cardiac natriuretic peptides as predictors of mortality

“…Fifthly, the prognosis for patients after acute myocardial infarction [24][25][26][27][28], or with established heart failure [29,30], is predicted by levels of cardiac natriuretic peptides or their amino-terminal peptides according to several authors.…”

Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure

“…This is a notable finding since natriuretic peptides have shown to correlate with changes in ventricular wall stress, are inversely related to the severity of left ventricular dysfunction, and are robust prognostic predictors in HF [22][23][24][25][26]. Despite no significant differences were found, patients in the treatment group had greater albuminuria reduction during the treatment period.…”