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BACH: MRproANP, MRproADM plus BNP improved acute HF diagnoses
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The addition of midregional pro-atrial natriuretic peptide to B-type natriuretic peptide added utility for the diagnosis of acute HF, study results from the BACH study suggested.
Researchers from various U.S. and international sites enrolled 1,641 patients with acute HF presenting to the ED with dyspnea. Patients underwent noninferiority diagnostic testing with midregional pro-atrial natriuretic peptide (MR-proANP) vs. B-type natriuretic peptide (BNP), coupled with a superiority test of the prognostic value of pro-adrenomedullin (MR-proADM) vs. BNP for survival at 90 days.
Acute HF was diagnosed in 568 patients. Results indicated that MRproANP (≥120 pmol/L) was noninferior to BNP (≥100 pg/mL) for the diagnosis of acute HF. The absolute difference in accuracy was 0.9%, with the upper 95% CI for the difference falling below the prespecified noninferiority margin of 10% (P<.001). Elevated MRproANP added to the utility of BNP in patients with intermediate BNP values and obesity (P<.001). Following univariate Cox proportional hazard analyses, all three biomarkers were prognostic of survival at 90 days.
“This multinational trial, the largest of its kind to date, demonstrated that midregion prohormone markers have significant diagnostic and prognostic utility in patients presenting in the ED with acute dyspnea,” the researchers wrote. “Our findings validate and extend the observations made in previous pilot studies using MR-proANP for the diagnosis of HF and MR-proADM for the assessment of prognosis.”
Maisel A. J Am Coll Cardiol. 2010;55:2062-2076.
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