Comparative Evaluation of B-Type Natriuretic Peptide, Mid-Regional Pro-A-type Natriuretic Peptide, Mid-Regional Pro-Adrenomedullin, and Copeptin to Predict 1-Year Mortality in Patients With Acute Destabilized Heart Failure

• Published in: Journal of cardiac failure 2007-02, Vol.13 (1), p.42-49
• Main Authors: Gegenhuber, Alfons, MD, Struck, Joachim, PhD, Dieplinger, Benjamin, MD, Poelz, Werner, PhD, Pacher, Richard, MD, Morgenthaler, Nils G., PhD, Bergmann, Andreas, PhD, Haltmayer, Meinhard, MD, Mueller, Thomas, MD
• Format: Article
• Language: English
• Subjects: Adrenomedullin; Aged; Aged, 80 and over; Atrial Natriuretic Factor - blood; Cardiovascular; Female; Glycopeptides - blood; Heart Failure - blood; Heart Failure - mortality; Humans; Male; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Predictive Value of Tests; Prognosis; Protein Precursors - blood; Proteins; ROC Curve; Vasopressin
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2006.09.004

Abstract Background The aim of the present study was to evaluate the capability B-type natriuretic peptide (BNP) as a prognostic marker in patients with acute destabilized heart failure in comparison with mid-regional pro-A-type natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin (MR-proADM), and the C-terminal part of the arginine vasopressin prohormone (Copeptin). Methods and Results BNP, MR-proANP, MR-proADM, and Copeptin plasma concentrations were obtained in 137 patients with acute destabilized heart failure attending a tertiary care hospital. The end point was defined as all-cause mortality, and the study participants were followed for 365 days. Of the 137 patients enrolled, 41 died and 96 survived during follow-up. ROC curve analysis showed that the areas under curve for the prediction of 1-year mortality were similar for BNP (0.716; 95% CI 0.633–0.790), MR-proANP (0.725; 95% CI 0.642–0.798), MR-proADM (0.708; 95% CI 0.624–0.782), and Copeptin (0.688; 95% CI 0.603–0.764). Using tercile approaches, Kaplan-Meier curve analyses demonstrated that the predictive value of all four analytes for survival probability was comparable (log-rank test for trend, P < .001 for each). In multivariable Cox proportional-hazards regression analyses, increased BNP, MR-proANP, MR-proADM, and Copeptin plasma concentrations were the strongest predictors of mortality. Conclusion BNP is considered an established prognostic marker for heart failure patients. The present study provides evidence that MR-proANP, MR-proADM, and Copeptin measurements might have similar predictive properties compared with BNP determinations for one-year all-cause mortality in acute destabilized heart failure.