Neuroendocrine testing in community patients with heart disease: plasma N-terminal proatrial natriuretic peptide predicts morbidity and mortality stronger than catecholamines and heart rate variability.

Abstract

BACKGROUND:

Patients with heart disease are at risk of developing congestive heart failure (CHF). Neurohormonal activation may make an important contribution.

AIM:

In stable heart patients from primary care, to examine neuroendocrine markers of cardiac performance for the association to cardiac dysfunction, morbidity and mortality.

METHODS:

Plasma N-terminal atrial natriuretic peptide (N-ANP), catecholamines, 24-h ECG and blood pressure, serum urea and creatinine, echocardiography, chest X-ray and physical examination were performed. Death was recorded during 5 to 7 years of follow-up.

RESULTS:

The study included 56 patients. Mean age was 71 years, 54% were men, 43% had clinical signs of CHF, 39 + 52 + 9% were in NYHA I + II + III, 34% had echocardiographic cardiac dysfunction, and 18 died during follow-up. N-ANP was related to all subtypes of cardiac dysfunction (p < 0.05). Catecholamines and premature ventricular captures (PVC) were related to valvular and systolic dysfunction, but heart rate variability and dipping blood pressure were not (p > 0.05). On multivariate analyses only, N-ANP and PVC were associated with clinical signs of CHF, echocardiographic cardiac dysfunction, and mortality (p < 0.05).

CONCLUSIONS:

Plasma N-ANP was stronger than catecholamines and variables of 24-h monitoring (blood pressure and electrocardiogram) in predicting morbidity and mortality, thereby supporting the use of cardiac natriuretic peptides (i.e. N-ANP, BNP, or N-BNP) as the most valuable biomarker in community patients at risk of CHF.

• Authors: O W Nielsen, V Rasmussen, N J Christensen, J F Hansen
• Journal: Scandinavian journal of clinical and laboratory investigation (Scand J Clin Lab Invest) Vol. 64 Issue 7 Pg. 619-28 ( 2004) ISSN: 0036-5513 [Print] England
• PMID: 15513318 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• N-terminal proatrial natriuretic peptide
• Protein Precursors
• Atrial Natriuretic Factor
• Norepinephrine
• Epinephrine

Topics

• Adult
• Aged
• Atrial Natriuretic Factor (blood)
• Community Health Services
• Epinephrine (blood)
• Female
• Heart Diseases (diagnosis, epidemiology, mortality)
• Heart Failure (diagnosis)
• Heart Rate (physiology)
• Humans
• Male
• Middle Aged
• Morbidity
• Norepinephrine (blood)
• Prognosis
• Protein Precursors (blood)
• Severity of Illness Index