https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitätsklinikum Hamburg-Eppendorf Klinik für Kardiologie Hamburg, Deutschland; 3Kardiologische Praxis Orchideenstieg Hamburg, Deutschland; 4Universitätsklinikum Hamburg-Eppendorf Klinik für Radiologie Hamburg, Deutschland; 5Universitätsklinikum Hamburg-Eppendorf Klinik für Neurologie Hamburg, Deutschland; 6Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
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). The current literature describes a relationship between elevated MRproANP and myocardial fibrosis. 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 the large, population-based Hamburg City Health Study (HCHS) and to evaluate its potential to identify subclinical cardiovascular disease in the population setting.
Methods. We used cross-sectional data from the first 10,000 participants enrolled in the HCHS. We analyzed self-reported CVD history and dedicated 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, and hypertension).
Results. A total of 7,339 participants with MRproANP measurements were included in the analysis. The median age was 63 years [IQR 55.0; 70.0] and 3,704 (50%) were women. The median level of MRproANP in the cohort was 65.0 pmol/L [IQR 48.0; 89.6]. Further, higher MRproANP levels were associated with markers of reduced myocardial function, myocardial fibrosis, and subclinical cardiovascular disease on cardiac imaging. In linear regression models, functional echocardiographic parameters such as left ventricular ejection fraction [Beta=-1.092; p = 0.014], left atrial ejection fraction [Beta=-12.304; p <0.001] and left atrial strain [Beta=-13.182; p <0.001] showed a negative association with MRproANP levels. Moreover, higher MRproANP was associated with elevated native myocardial T1 levels in CMR mapping analysis [OR=3.458; p<0.001] and elevated left ventricular end-diastolic volume in CMR [Beta=38.748; p<0.001], but not with the presence of late gadolinium enhancement (LGE) lesions [OR=1.116; p = 0.782]. We confirmed the association of logarithmic MRproANP with cardiovascular disease such as heart failure [OR=84.797, p<0.001] and atrial fibrillation [OR=186.069, p<0.001] 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 left ventricular function as well as diffuse myocardial fibrosis. Consequentially, determination of MRproANP levels may provide a reliable, non-invasive screening option for cardiovascular disease and, potentially, the prediction of cardiovascular events.