Interactions Between Atrial Fibrillation and Natriuretic Peptide in Predicting Heart Failure Hospitalization or Cardiovascular Death

Abstract

Background Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their value in predicting future cardiovascular events, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and outcomes. Methods and Results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital underwent clinical assessment, 7‐day ECG monitoring, and echocardiography to diagnose AF and HF. NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) was centrally quantified. Based on a literature review, four NT‐proBNP groups were defined (<300, 300–999, 1000–1999, and ≥2000 pg/mL). Clinical characteristics and NT‐proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow‐up data were available in 1616 of 1621 patients (99.7%) and analysis performed at 2.5 years (median age, 70 [interquartile range, 60–78] years; 40% women). HF hospitalization or cardiovascular death increased from 36 of 488 (3.2/100 person‐years) in patients with neither AF nor HF, to 55 of 354 (7.1/100 person‐years) in patients with AF only, 92 of 369 (12.1/100 person‐years) in patients with HF only, and 128 of 405 (17.7/100 person‐years) in patients with AF plus HF ( P <0.001). Higher NT‐proBNP concentrations predicted the outcome in patients with AF only (C‐statistic, 0.82; 95% CI, 0.77–0.86; P <0.001) and in other phenotype groups (C‐statistic in AF plus HF, 0.66; [95% CI, 0.61–0.70]; P <0.001). Conclusions Elevated NT‐proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF, encouraging routine quantification of NT‐proBNP in the assessment of patients with AF.

Relationship of diabetes, heart failure, and N‐terminal pro‐B‐type natriuretic peptide with cardiovascular outcomes in patients with atrial fibrillation

“…Moreover, clinical outcomes were not adjudicated and therefore inaccurate diagnoses as well as underreporting are possible. However, we found that the event rates were similar to those reported in a recently published contemporary study 40 . We also did not have echocardiographic assessment of the left atrial structure and function or information on medications for all patients 41,42 .…”

“…However, we found that the event rates were similar to those reported in a recently published contemporary study. 40 We also did not have echocardiographic assessment of the left atrial structure and function or information on medications for all patients. 41 , 42 Also, laboratory measurements were only available for a subset of patients introducing possible selection bias.…”

The predictive role of N-terminal pro-B-type natriuretic peptide in assessing outcomes for atrial fibrillation patients, with or without heart failure: a comprehensive systematic review and meta-analysis

“…The follow-up duration ranged from 1.0 to 5.2 years. Of 16 studies included, only two studies presented data on patients with AF without HF [3,18] . The characteristics of the included studies are summarized in Table 1.…”

“…Nine studies [2][3][4][9][10][11][12]14,16] reported MACE in AF patients, among which one study divided patient group into AF without HF and AF with HF (Figure 4). AF without HF group labeled as Brady 2022, while AF with HF labeled as Brady PF 2022 in Figure 4.…”

Metalloproteinase (Neprilysin) and Natriuretic Peptides: Relationship of Metabolic Effects and Clinical Significance in Patients with Heart Failure and Atrial Fibrillation

“…Результаты, близкие к нашим, получены в исследовании P.F. Brady [31], в котором повышение NT-proBNP ≥1000 нг/л имеет последовательную связь с будущей госпитализацией по поводу СН или смертью от сердечно-сосудистых заболеваний (ССЗ) у пациентов с ФП с СН. NT-proBNP сохраняет прогностическую значимость у пациентов с СН и ФП [32].…”