CARDIAC NATRIURETIC PEPTIDES FOR DIAGNOSIS AND RISK STRATIFICATION INHEART-FAILURE - INFLUENCES OF LEFT-VENTRICULAR DYSFUNCTION AND CORONARY-ARTERY DISEASE ON CARDIAC HORMONAL ACTIVATION

Background Cardiac natriuretic peptides are activated in heart failure . However, their diagnostic and prognostic Values have not been compar ed under the routine conditions of an outpatient practice. Methods We studied the diagnostic and prognostic value of plasma N- and C-termina l peptides of the atrial natriuretic factor prohormone (N-proANF and A NF respectively) and brain natriuretic peptide (BNP) to evaluate the s everity of congestive heart failure (CHF) as reflected by the New York Heart Association (NYHA) classification and to predict its 2-year mor tality. Peripheral plasma concentrations of the three natriuretic pept ides were measured in 27 normal subjects (CTR), in 32 patients with co ronary artery disease (CAD) and normal left ventricular ejection fract ion and in 101 patients with chronic CHF in functional classes I and I I (n = 61) or III and IV (rr = 40). Results Plasma concentrations of t he three peptides increased in the presence of CHF in relation to its severity (P< 0.01). BNP was unable to distinguish CTR from CAD, just a s ANF could not differentiate CAD from CHF I-II; only N-proANF display ed a significant and continuous increase from CTR to CAD, CHF I-II and III-IV. Receiver-operating characteristic curves showed better evalua tion of the degree of CHF by BNP than by ANF or ejection fraction (P < 0.05). Assessment of the 2-year prognosis revealed that N-proANF and BNP were the best independent predictors of outcome after the NYHA cla ssification. These peptides identify a very high-mortality group. Conc lusion Plasma N-proANF and BNP concentrations are good indicators of t he severity and prognosis of CHF in an outpatient practice. CAD does n ot stimulate BNP as long as ventricular dysfunction is not present, al though increased N-proANF levels in this setting suggest an early humo ral activation.