ASSOCIATIONS BETWEEN ATRIAL NATRIURETIC PEPTIDES, ECHOCARDIOGRAPHIC FINDINGS AND MORTALITY IN AN ELDERLY POPULATION-SAMPLE

Objectives. To examine associations of N-terminal and C-terminal compo nents of the proatrial natriuretic peptide [ANP (1-98) and ANP(99-126) , respectively], with echocardiographic measurements of left ventricul ar structure and performance and with the function of the aortic and m itral valves in old age. To compare the predictive value of the atrial peptides and echocardiographic data for short-term mortality. Design. A population-based survey with 1.5-year mortality follow-up. Setting. University hospital. Subjects. Three-hundred and thirty-three people aged 78-88 years. Main outcome measures. (i) Plasma ANP (1-98) and ANP (99-126); (ii) M-mode and Doppler echocardiographic measurements of le ft atrial diameter; left ventricular diameters, mass and fractional sh ortening; peak transmitral velocities; aortic valve area, aortic regur gitation jet length and mitral regurgitant jet area; (iii) total and c ardiovascular 1.5-year mortality. Results. ANP (1-98) correlated with left atrial diameter (r = 0.33; P < 0.001), left ventricular mass (r = 0.19; P < 0.001), fractional shortening (r = -0.16; P < 0.01) and the early-to-atrial peak transmitral velocity ratio (r = 0.23; P < 0.001) . Also, ANP(1-98) predicted the degree of aortic valve obstruction and the severity of aortic and mitral regurgitation. Associations of ANP( 99-126) with echocardiographic data were much weaker. Aortic valve ste nosis and ANP(1-98) were independent predictors of age-and sex-adjuste d total and cardiovascular mortality at 1.5 years of entry. Conclusion s. Circulating ANP (1-98) correlates with left atrial size, with left ventricular mass and performance and with the severity of aortic and m itral valve dysfunction in persons representing the general elderly po pulation. ANP(1-98) also predicts both total and cardiovascular mortal ity.