N-TERMINAL PROATRIAL NATRIURETIC FACTOR - AN INDEPENDENT PREDICTOR OFLONG-TERM PROGNOSIS AFTER MYOCARDIAL-INFARCTION

Background Atrial natriuretic factor (ANF) is a peptide hormone secret ed from cardiac atria in response to increased atrial pressure. Becaus e of a longer half-life and greater stability, the N-terminal of ANF p rohormone (N-terminal proANF) may be a better integrator of atrial pep tide secretion than ANF itself. After myocardial infarction, elevation of ANF and other neurohormones has been associated with a poor progno sis. However, when left ventricular ejection fraction (LVEF) and other important clinical variables are included in multivariate analysis, t he independent predictive value of these neurohormones has been reduce d markedly. Methods and Results To test the prognostic value of N-term inal proANF after myocardial infarction, its plasma concentration was measured a mean of 12 days after infarction in 246 patients in the Sur vival and Ventricular Enlargement (SAVE) Study. N-terminal proANF was a much stronger predictor of survival than ANF itself. Furthermore, in multivariate analysis of cardiovascular mortality and development of heart failure, N-terminal proANF in contrast to ANF and other neurohor mones was still a powerful and independent predictor when the model in cluded age, gender, prior myocardial infarction, hypertension, diabete s, use of thrombolysis, Killip class, infarct location, and LVEF. Conc lusions The measurement of N-terminal proANF supplements presently use d clinical and objective assessments and provides an important indepen dent predictor of prognosis with respect to cardiovascular mortality a nd development of heart failure.