Background: Amino-terminal-pro-B-type-natriuretic-peptide (NT-proBNP) is a diagnostic biomarker for heart failure (HF), but plasma concentrations are influenced by numerous factors. Mid-regional-pro-atrial-natriuretic-peptide (MR-proANP) have comparable diagnostic value in acute HF. However, data are lacking in the non-acute setting. This study sought to assess the diagnostic utility of MR-proANP in outpatients with a high risk of HF.Methods: This prospective study included 399 outpatients. Inclusion criteria were: age ≥ 60 years, ≥1 risk factor for HF (diabetes, chronic kidney disease, vascular disease, atrial fibrillation, hypertension), without known or suspected HF. Unrecognized HF was diagnosed based on clinical signs, patient-reported symptoms and echocardiography. Plasma concentrations of MR-proANP and NT-proBNP were analysed.Results: In total, 65 patients were diagnosed with HF or asymptomatic left ventricular systolic dysfunction (N = 12 LVEF ≤ 40%, N = 7 LVEF > 40% to ≤50%, N = 46 LVEF > 50%). Both MR-proANP (odds-ratio: 1.77; 95% CI:1.16-2.72; p = 0.009) and NT-proBNP (odds-ratio: 1.49; 95% CI:1.22-1.82; p < 0.001) were associated with HF. Area under receiver-operator characteristics curve (AUC) for the diagnosis of HF or asymptomatic left ventricular systolic dysfunction was higher for MR-proANP (AUC = 0.886; p < 0.001) and NT-proBNP (AUC = 0.910; p < 0.001) compared to patient-reported symptoms of HF (AUC = 0.830), but NT-proBNP added more diagnostic information compared to MR-proANP (p = 0.022).Conclusions: Both NT-proBNP and MR-proANP are useful biomarkers in the diagnosis of HF or asymptomatic left ventricular systolic dysfunction in a non-acute setting. However, NT-proBNP added more diagnostic information compared to MR-proANP.

中文翻译：

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MR-proANP和NT-proBNP在具有高心衰风险的老年门诊患者中的诊断作用：哥本哈根心衰风险研究。

背景：氨基末端B型钠尿肽（NT-proBNP）是心力衰竭（HF）的诊断生物标志物，但血浆浓度受多种因素影响。心房钠利尿肽前区（MR-proANP）在急性心力衰竭中具有可比的诊断价值。但是，非急性设置中缺少数据。这项研究旨在评估MR-proANP在HF高危门诊中的诊断作用。方法：该前瞻性研究包括399名门诊患者。纳入标准为：年龄≥60岁，≥1的HF危险因素（糖尿病，慢性肾脏疾病，血管疾病，心房颤动，高血压），无已知或疑似HF。根据临床体征，患者报告的症状和超声心动图诊断为无法识别的HF。分析了MR-proANP和NT-proBNP的血浆浓度。总共65例患者被诊断为心力衰竭或无症状左心室收缩功能不全（N = 12 LVEF≤40％，N = 7 LVEF> 40％至≤50％，N = 46 LVEF> 50％）。MR-proANP（奇数比：1.77; 95％CI：1.16-2.72; p = 0.009）和NT-proBNP（奇数比：1.49; 95％CI：1.22-1.82; p <0.001）与HF相关。与MR-proANP（AUC = 0.886; p <0.001）和NT-proBNP（AUC = 0.910; p <0.001）相比，接受者-操作者特征曲线（AUC）下用于诊断HF或无症状左心室收缩功能障碍的面积更高患者报告的心衰症状（AUC = 0.830），但与MR-proANP相比，NT-proBNP增加了更多的诊断信息（p = 0.022）。结论：NT-proBNP和MR-proANP都是诊断HF的有用生物标志物或在非急性情况下无症状的左心室收缩功能障碍。