Mid‐regional pro‐adrenomedullin outperforms N‐terminal pro‐B‐type natriuretic peptide for the diagnosis of acute heart failure in the presence of atrial fibrillation

• Published in: European journal of heart failure 2020-04, Vol.22 (4), p.692-700
• Main Authors: Kuan, Win Sen, Ibrahim, Irwani, Chan, Siew Pang, Li, Zisheng, Liew, Oi Wah, Frampton, Chris, Troughton, Richard, Pemberton, Chris J., Chong, Jenny Pek Ching, Tan, Li Ling, Lin, Weiqin, Ooi, Shirley Beng Suat, Richards, A. Mark
• Format: Article
• Language: English
• Subjects: Acute heart failure; Adrenomedullin; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Biomarkers; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - epidemiology; Humans; MR‐proADM; Natriuretic Peptide, Brain; New Zealand; NT‐proBNP; Peptide Fragments; Protein Precursors; Singapore - epidemiology
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.1660

Aims The performance of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in diagnosing acute decompensated heart failure (ADHF) among patients presenting with breathlessness is markedly impaired in the presence of atrial fibrillation (AF). We evaluated the diagnostic performance of mid‐regional pro‐adrenomedullin (MR‐proADM) and cardiac troponin T as possible alternative markers for discrimination of ADHF in this setting. Methods and results Breathless patients (n = 1107) were prospectively and contemporaneously recruited in emergency departments in Singapore and New Zealand. The diagnoses of ADHF and presence of AF were adjudicated by two clinician specialists, blinded to MR‐proADM, NT‐proBNP and high‐sensitivity cardiac troponin T (hs‐cTnT) results. MR‐proADM exhibited strong discrimination of ADHF with little change in performance irrespective of the presence of AF (area under the curve 0.83 in non‐AF vs. 0.76 in AF) compared to NT‐proBNP (0.91 vs. 0.71) and hs‐cTnT (0.83 vs. 0.62), respectively. The accuracy of MR‐proADM (73.3%) for diagnosing ADHF among patients with AF was superior to both NT‐proBNP (61.6%) and hs‐cTnT (64.6%). The superior performance of MR‐proADM remained apparent when data from Singapore and New Zealand were analysed separately. Conclusion In the presence of AF, MR‐proADM showed greater discrimination and accuracy, and less impairment in performance compared to that in non‐AF cases, for the diagnosis of ADHF, compared to the guideline‐endorsed NT‐proBNP.