MRproANP: a promising biomarker for left-atrial and left-ventricular remodeling

Abstract Background Midregional pro-atrial natriuretic peptide (MRproANP) has emerged as a promising biomarker to predict adverse events in the early stages of cardiovascular disease (CVD) (1). The current literature describes a relationship between elevated MRproANP and myocardial fibrosis (2,3). However, little is known on the association of elevated MRproANP with left-atrial and left-ventricular imaging markers in a population-based setting. Purpose This study aimed to explore the relationship of MRproANP levels and imaging-based markers in a large, population-based study and to evaluate its potential to identify subclinical cardiovascular disease in the population setting. Methods We used cross-sectional data from 7,339 participants with MRproANP measurements and self-reported CVD history as well as cardiovascular examinations including biomarker profiles, electrocardiogram, echocardiography, and cardiac magnetic resonance tomography (CMR). Multivariable linear and logistic regression models were used to calculate beta estimates Beta, Odds Ratios OR and p values adjusted for classical cardiovascular risk factors (age, sex, BMI, smoking status, diabetes, dyslipidaemia, hypertension). Results A total of 1,901 participants with both MRproANP and imaging measurements were included in the final analysis. The median age was 67 years IQR 59.0; 72.0 and 766 (40%) were women. The median level of MRproANP in the cohort was 69.0 pmol/L IQR 50.2; 96.4. In linear regression models, functional echocardiographic parameters such as left atrial ejection fraction Beta=-13.48; p 0.001, left atrial strain Beta=-12.20; p 0.001 and left ventricular ejection fraction Beta=-1.20, p=0.027 showed a negative association with MRproANP levels (Figure 1). Moreover, within CMR analysis higher MRproANP was positively associated with native myocardial T1 levels in CMR mapping OR=3.44; p0.001, extracellular volume fraction OR=2.37; p0.001, left atrial volume Beta=40.66; p0.001 as well as left ventricular end-diastolic volume index Beta=18.99, p0.001. In logistic regression models, higher MRproANP was not significantly linked to the presence of late gadolinium enhancement (LGE) lesions OR=1.219; p = 0.616. We confirmed the association of elevated MRproANP with classical CVD such as heart failure OR=63.93, p0.001 and atrial fibrillation OR=244.83, p0.001 in the population setting. Conclusion Our study shows an association between MRproANP and early signs of left-atrial and left-ventricular remodeling, derived from comprehensive multimodal imaging. Our results suggest that MRproANP is a promising biomarker for early identification of myocardial remodeling, such as reduced left atrial and ventricular function as well as diffuse myocardial fibrosis. Consequentially, determination of MRproANP levels may provide a reliable, non-invasive screening option for cardiac remodeling and, potentially, the prediction of cardiovascular events.Figure 1