Mid-Region Pro-Hormone Markers for Diagnosis and Prognosis in Acute Dyspnea Results From the BACH (Biomarkers in Acute Heart Failure) Trial

被引：416

作者：

Maisel, Alan ^{[1
]}

Mueller, Christian ^{[2
]}

Nowak, Richard ^{[3
]}

Peacock, W. Frank ^{[4
]}

Landsberg, Judd W. ^{[5
,6
]}

Ponikowski, Piotr ^{[7
]}

Mockel, Martin ^{[8
]}

Hogan, Christopher ^{[9
]}

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

Richards, Mark ^{[11
]}

Clopton, Paul ^{[1
]}

Filippatos, Gerasimos S. ^{[12
]}

Di Somma, Salvatore ^{[13
]}

Anand, Inder ^{[14
]}

Ng, Leong ^{[15
]}

Daniels, Lori B.

Neath, Sean-Xavier

Christenson, Robert ^{[17
]}

Potocki, Mihael ^{[2
]}

McCord, James ^{[3
]}

Terracciano, Garret ^{[16
]}

Kremastinos, Dimitrios ^{[12
]}

Hartmann, Oliver ^{[18
]}

von Haehling, Stephan ^{[10
]}

Bergmann, Andreas ^{[18
]}

Morgenthaler, Nils G. ^{[18
]}

Anker, Stefan D. ^{[8
,19
]}

机构：

[1] VA San Diego Healthcare Syst, San Diego, CA USA

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

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

[4] Cleveland Clin, Cleveland, OH 44106 USA

[5] Univ Calif San Diego, La Jolla, CA 92093 USA

[6] Vet Adm Med Ctr, San Diego Sch Med, Med Intens Care Unit, La Jolla, CA 90034 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] Univ Otago, Christchurch, New Zealand

[12] Athens Univ Hosp Attikon, Athens, Greece

[13] Univ Roma La Sapienza, St Andrea Hosp, Rome, Italy

[14] VA Minneapolis, Minneapolis, MN USA

[15] Univ Leicester, Leicester, Leics, England

[16] Univ Calif San Diego, San Diego Sch Med, San Diego, CA 92103 USA

[17] Univ Maryland, Baltimore, MD 21201 USA

[18] BRAHMS Aktiengesell Biotechnol Ctr Hennigsdorf, Berlin, Germany

[19] IRCCS San Raffaele, Ctr Clin & Basic Res, Rome, Italy

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2010年 / 55卷 / 19期

关键词：

pro-hormone; markers; acute dyspnea; BACH; PROATRIAL NATRIURETIC PEPTIDE; COMMUNITY-ACQUIRED PNEUMONIA; ACUTE MYOCARDIAL-INFARCTION; A-TYPE; MIDREGIONAL PROADRENOMEDULLIN; IMMUNOLUMINOMETRIC ASSAY; PRO-ADRENOMEDULLIN; PLASMA; GUIDELINES; MORTALITY;

D O I：

10.1016/j.jacc.2010.02.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives Our purpose was to assess the diagnostic utility of mid-regional pro-atrial natriuretic peptide (MR-proANP) for the diagnosis of acute heart failure (AHF) and the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with AHF. Background There are some caveats and limitations to natriuretic peptide testing in the acute dyspneic patient. Methods The BACH (Biomarkers in Acute Heart Failure) trial was a prospective, 15-center, international study of 1,641 patients presenting to the emergency department with dyspnea. A noninferiority test of MR-proANP versus B-type natriuretic peptide (BNP) for diagnosis of AHF and a superiority test of MR-proADM versus BNP for 90-day survival were conducted. Other end points were exploratory. Results MR-proANP (>120 pmol/l) proved noninferior to BNP (>100 pg/ml) for the diagnosis of AHF (accuracy difference 0.9%). In tests of secondary diagnostic objectives, MR-proANP levels added to the utility of BNP levels in patients with intermediate BNP values and with obesity but not in renal insufficiency, the elderly, or patients with edema. Using cut-off values from receiver-operating characteristic analysis, the accuracy to predict 90-day survival of heart failure patients was 73% (95% confidence interval: 70% to 77%) for MR-proADM and 62% (95% confidence interval: 58% to 66%) for BNP (difference p < 0.001). In adjusted multivariable Cox regression, MR-proADM, but not BNP, carried independent prognostic value (p < 0.001). Results were consistent using NT-proBNP instead of BNP (p < 0.001). None of the biomarkers was able to predict rehospitalization or visits to the emergency department with clinical relevance. Conclusions MR-proANP is as useful as BNP for AHF diagnosis in dyspneic patients and may provide additional clinical utility when BNP is difficult to interpret. MR-proADM identifies patients with high 90-day mortality risk and adds prognostic value to BNP. (Biomarkers in Acute Heart Failure [BACH]; NCT00537628) (J Am Coll Cardiol 2010;55:2062-76) (C) 2010 by the American College of Cardiology Foundation

引用

页码：2062 / 2076

页数：15

共 30 条

[1] Molecular heterogeneity has a major impact on the measurement of circulating N-terminal fragments of A- and B-type natriuretic peptides [J].