The plasma concentration of N‐terminal proatrial natriuretic factor anf (1‐98) is related to prognosis in severe heart failure

Due to its longer halflife, the N‐terminal of ANF prohormone, ANF( 1‐98), has plasma concentrations that exceed those of ANF itself by a factor of 10 or more. It is also less prone to rapid changes secondary to hemodynamic alterations. To evaluate the prognostic significance of ANF(1‐98) plasma levels in severe heart failure (NYHA IV), the peptide was measured by radioimmunoassay in plasma samples from patients randomized to additional treatment with enalapril (n = 78) or placebo (n = 61) (CONSENSUS study). In the placebo group there was a positive relation between mortality after 6 months and baseline ANF(1‐98) level. Because of a reduced mortality, especially among patients with high ANF(l‐98) levels, there was no such relation in the patients treated with enalapril. For both groups there was a positive relationship between increase in ANF(1‐98) after 6 weeks of treatment and mortality, while a decrease signaled a favorable prognosis. It is concluded that the magnitude and changes of plasma ANF(1‐98) provide information on prognosis and therapeutic effects with respect to mortality in patients with severe heart failure. Plasma ANF(1‐98) may serve as a useful clinical biochemical parameter in the treatment of heart failure.