Please use this identifier to cite or link to this item: https://doi.org/10.1002/ejhf.1660
Title: Mid-regional pro-adrenomedullin outperforms N-terminal pro-B-type natriuretic peptide for the diagnosis of acute heart failure in the presence of atrial fibrillation
Authors: Kuan, Win Sen 
Ibrahim, Irwani 
Chan, S.P. 
LI ZISHENG 
Liew, O.W. 
Frampton, Chris
Troughton, Richard
Pemberton, Chris J
JENNY CHONG PEK CHING 
TAN LI LING 
LIN WEIQIN 
Ooi, S.B.S. 
Richards, A.M. 
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
MR-proADM
NT-proBNP
Acute heart failure
Atrial fibrillation
BIOMARKERS
EPIDEMIOLOGY
PERFORMANCE
MANAGEMENT
PROGNOSIS
STATEMENT
BACH
Issue Date: 6-Dec-2019
Publisher: WILEY
Citation: Kuan, Win Sen, Ibrahim, Irwani, Chan, S.P., LI ZISHENG, Liew, O.W., Frampton, Chris, Troughton, Richard, Pemberton, Chris J, JENNY CHONG PEK CHING, TAN LI LING, LIN WEIQIN, Ooi, S.B.S., Richards, A.M. (2019-12-06). Mid-regional pro-adrenomedullin outperforms N-terminal pro-B-type natriuretic peptide for the diagnosis of acute heart failure in the presence of atrial fibrillation. EUROPEAN JOURNAL OF HEART FAILURE 22 (4) : 692-700. ScholarBank@NUS Repository. https://doi.org/10.1002/ejhf.1660
Abstract: Aims: The performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in diagnosing acute decompensated heart failure (ADHF) among patients presenting with breathlessness is markedly impaired in the presence of atrial fibrillation (AF). We evaluated the diagnostic performance of mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin T as possible alternative markers for discrimination of ADHF in this setting. Methods and results: Breathless patients (n = 1107) were prospectively and contemporaneously recruited in emergency departments in Singapore and New Zealand. The diagnoses of ADHF and presence of AF were adjudicated by two clinician specialists, blinded to MR-proADM, NT-proBNP and high-sensitivity cardiac troponin T (hs-cTnT) results. MR-proADM exhibited strong discrimination of ADHF with little change in performance irrespective of the presence of AF (area under the curve 0.83 in non-AF vs. 0.76 in AF) compared to NT-proBNP (0.91 vs. 0.71) and hs-cTnT (0.83 vs. 0.62), respectively. The accuracy of MR-proADM (73.3%) for diagnosing ADHF among patients with AF was superior to both NT-proBNP (61.6%) and hs-cTnT (64.6%). The superior performance of MR-proADM remained apparent when data from Singapore and New Zealand were analysed separately. Conclusion: In the presence of AF, MR-proADM showed greater discrimination and accuracy, and less impairment in performance compared to that in non-AF cases, for the diagnosis of ADHF, compared to the guideline-endorsed NT-proBNP.
Source Title: EUROPEAN JOURNAL OF HEART FAILURE
URI: https://scholarbank.nus.edu.sg/handle/10635/201971
ISBN: 1879-0844
ISSN: 1388-9842
DOI: 10.1002/ejhf.1660
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