Atrial Fibrillation Impairs the Diagnostic Performance of Cardiac Natriuretic Peptides in Dyspneic Patients Results From the BACH Study (Biomarkers in ACute Heart Failure)

被引：104

作者：

Richards, Mark ^{[1
,2
]}

Di Somma, Salvatore ^{[3
]}

Mueller, Christian ^{[4
]}

Nowak, Richard ^{[5
]}

Peacock, W. Frank ^{[6
]}

Ponikowski, Piotr ^{[7
]}

Mockel, Martin ^{[8
]}

Hogan, Christopher ^{[9
]}

Wu, Alan H. B. ^{[10
]}

Clopton, Paul ^{[11
]}

Filippatos, Gerasimos S. ^{[12
]}

Anand, Inder ^{[13
]}

Ng, Leong ^{[14
]}

Daniels, Lori B. ^{[15
]}

Neath, Sean-Xavier ^{[16
]}

Shah, Kevin ^{[3
,11
]}

Christenson, Robert ^{[16
]}

Hartmann, Oliver ^{[17
]}

Anker, Stefan D. ^{[8
,18
]}

Maisel, Alan ^{[15
]}

机构：

[1] Univ Otago, Christchurch, New Zealand

[2] Natl Univ Singapore, Ctr Heart, Singapore, Singapore

[3] Univ Roma La Sapienza, St Andreas Hosp, Rome, Italy

[4] Univ Basel Hosp, CH-4031 Basel, Switzerland

[5] Henry Ford Hlth Syst, Detroit, MI USA

[6] Cleveland Clin, Cleveland, OH 44106 USA

[7] Med Univ, Fac Publ Hlth, Wroclaw, Poland

[8] Campus Virchow Klinikum, Charite, Berlin, Germany

[9] Virginia Commonwealth Univ, Richmond, VA USA

[10] Univ Calif San Francisco, San Francisco, CA 94143 USA

[11] Vet Adm San Diego Healthcare Syst, San Diego, CA USA

[12] Univ Athens, Hosp Attikon, Athens, Greece

[13] Vet Adm Minneapolis, Minneapolis, MN USA

[14] Univ Leicester, Leicester, Leics, England

[15] Univ Calif San Diego, San Diego, CA USA

[16] Univ Maryland, Baltimore, MD 21201 USA

[17] BRAHMS Aktiengesellschaft Biotechnol Ctr Hennigsd, Berlin, Germany

[18] Ctr Clin & Basic Res IRCCS, Rome, Italy

来源：

JACC-HEART FAILURE | 2013年 / 1卷 / 03期

关键词：

atrial fibrillation; heart failure; natriuretic peptides; RISK-FACTORS; NT-PROBNP; CARDIOVERSION; MANAGEMENT; PROGNOSIS; DETERMINANTS; EXPRESSION; MORTALITY; RHYTHM;

D O I：

10.1016/j.jchf.2013.02.004

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients. Background The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported. Methods A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF. Results AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality. Conclusions AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF. (c) 2013 by the American College of Cardiology Foundation

引用

页码：192 / 199

页数：8

共 34 条

[1] INDEPENDENT RISK-FACTORS FOR ATRIAL-FIBRILLATION IN A POPULATION-BASED COHORT - THE FRAMINGHAM HEART-STUDY [J].