Influence of age, race, sex, and body mass index on interpretation of midregional pro atrial natriuretic peptide for the diagnosis of acute heart failure: Results from the BACH multinational study

Lori B. Daniels, Paul Clopton, Mihael Potocki, Christian Mueller, James McCord, Mark Richards, Oliver Hartmann, Inder S. Anand, Alan H B Wu, Richard Nowak, W. Frank Peacock, Piotr Ponikowski, Martin Mockel, Christopher Hogan, Gerasimos S. Filippatos, Salvatore Di Somma, Leong Ng, Sean Xavier Neath, Robert Christenson, Nils G. MorgenthalerStefan D. Anker, Alan S. Maisel

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Aims Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF. Methods and results The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90 sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old. Conclusion Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity.

Original languageEnglish (US)
Pages (from-to)22-31
Number of pages10
JournalEuropean Journal of Heart Failure
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2012

Keywords

  • Age
  • Gender
  • Heart failure
  • Midregional pro atrial natriuretic peptide
  • Obesity
  • Race

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