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

Clin Cardiol. 1994 Apr;17(4):191-5. doi: 10.1002/clc.4960170409.


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(1-98) 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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Atrial Natriuretic Factor / blood*
  • Enalapril / therapeutic use
  • Female
  • Heart Failure / blood*
  • Heart Failure / drug therapy*
  • Humans
  • Life Tables
  • Male
  • Norepinephrine / blood
  • Peptide Fragments
  • Placebos
  • Prognosis
  • Protein Precursors / blood*
  • Survival Rate


  • Peptide Fragments
  • Placebos
  • Protein Precursors
  • atrial natriuretic factor prohormone (1-98)
  • Enalapril
  • Atrial Natriuretic Factor
  • Norepinephrine