N-Terminal Pro–B-Type Natriuretic Peptide for Risk Assessment in Patients With Atrial Fibrillation

Hijazi, Ziad; Wallentin, Lars; Siegbahn, Agneta; Andersson, Ulrika; Christersson, Christina; Ezekowitz, Justin A.; Gersh, Bernard J.; Hanna, Michael; Hohnloser, Stefan H.; Horowitz, John D.; Huber, Kurt; Hylek, Elaine M.; Lópes, Renato D.; McMurray, John J.V.; Granger, Christopher B.

doi:10.1016/j.jacc.2012.11.082

Cited by 189 publications

(77 citation statements)

References 37 publications

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“…This finding adds to recent observations that NT-proBNP is an independent predictor of stroke risk in patients with AF. [29][30][31] A particular strength of this study is the validation of our predictive model in another data set. Consequently, our findings have clear clinical implications.…”

Section: Discussionmentioning

confidence: 99%

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Abdul-Rahim¹,

Perez²,

Fulton³

et al. 2015

Circulation

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Background— Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). Methods and Results— We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ 2 value): age (hazard ratio, 1.34; 95% confidence interval, 1.18–1.63 per 10 years), New York Heart Association class (1.60, 1.21–2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22–2.88), body mass index (0.74, 0.60–0.91 per 5 kg/m 2 up to 30), and previous stroke (1.81, 1.19–2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11–1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF. Conclusions— A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

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Section: Discussionmentioning

confidence: 99%

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Abdul-Rahim¹,

Perez²,

Fulton³

et al. 2015

Circulation

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“…38 Similar findings were demonstrated in another study, and the addition of NT-proBNP level to the CHA 2 DS 2 -VASc score improved its c-statistic from 0.62 to 0.65. 43 …”

Section: Prediction Of Stroke Risk Based On Serum Biomarkersmentioning

confidence: 99%

Stratifying Stroke Risk in Atrial Fibrillation

Yaghi

Kamel

2017

Stroke

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“…This association was also evident in the Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation (ARISTOTLE) trial population (hazard ratio, 2.35). 32 Among those at the low end of the risk spectrum, however, rising B-type natriuretic peptide did not exhibit a clear correlation with increased risk of thromboembolism, although event rates are too low in this subpopulation to allow definitive conclusions. Further exploration of this issue in larger cohorts of patients with AF may inform the assessment of the utility of biomarkers as predictors of thromboembolic risk and the need for anticoagulation when not otherwise clearly indicated on the basis of the medical history alone.…”

Section: Circulationmentioning

confidence: 79%

Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA ₂ DS ₂ -VASc Score 1 in Men, 2 in Women) Be Anticoagulated?

Savino

Halperin

2016

Circulation

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A s understanding of the pathophysiology of atrial fibrillation (AF) has evolved, so has appreciation of the associated risk of ischemic stroke. The 2014 American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines for management of patients with AF aligned with the 2012 European Society of Cardiology guidelines in recommending the CHA 2 DS 2 -VASc schema to stratify thromboembolic risk, 1,2 allotting 1 point each for congestive heart failure, hypertension, age ≥65 years, diabetes mellitus and vascular disease (history of myocardial infarction, peripheral artery disease, or morphologically complex aortic atheroma), or female sex and 2 points each for age ≥75 years or prior stroke, transient ischemic attack, or systemic embolism. Although there is concordance across most of the guideline recommendations, the decision to initiate systemic anticoagulation for men with CHA 2 DS 2 -VASc scores of 1 or for women with scores of 2 (1 risk factor other than sex) is controversial. The European Society of Cardiology guidelines recommend systemic oral anticoagulation (OAC) therapy for men with scores of 1 and for women with scores of 2. The American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines recommended OAC for those with scores ≥2 and no antithrombotic therapy for those with scores of 0; for those with scores of 1, no therapy, aspirin, and systemic OAC were each deemed acceptable options. The difference could swing the proportion of patients managed with anticoagulation by ≈5%, which in the United States alone involves more than a quarter of a million individuals. Below, we describe the methodology behind stroke risk assessment for patients with AF and point out the heterogeneity of those near the lower end of the stroke risk spectrum. Response by Lip and Nielsen on p 1511 Assessment of the CHA 2 DS 2 -VASc SchemaStroke is the second leading cause of death, according to the World Health Organization, 3 although the incidence of stroke has declined. The 2004 Oxford Vascular Study Investigators observed a 33% reduction in stroke between 1981 and 2004 despite the increasing age of the population, attributing it to improved modification of stroke risk factors, including hypertension, hyperlipidemia, and tobacco use. Recognition of the link between AF and ischemic stroke prompted greater use of prophylactic OAC during this period, contributing to the decline. Although CHA 2 DS 2 -VASc has been accepted internationally as a practical stroke risk prediction tool for application to patients with AF, earlier and more recently proposed risk models may predict risk more accurately in specific patient populations.The Atrial Fibrillation Investigators (AFI) used 5 early AF trials of warfarin and aspirin to derive a schema that included previous stroke, age ≥65 years, diabetes mellitus, and hypertension as risk factors for future stroke.4 Those ≥65 years of age with any risk factor were considered at high risk; those

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N-Terminal Pro–B-Type Natriuretic Peptide for Risk Assessment in Patients With Atrial Fibrillation

Cited by 189 publications

References 37 publications

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Stratifying Stroke Risk in Atrial Fibrillation

Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA ₂ DS ₂ -VASc Score 1 in Men, 2 in Women) Be Anticoagulated?

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N-Terminal Pro–B-Type Natriuretic Peptide for Risk Assessment in Patients With Atrial Fibrillation

Cited by 189 publications

References 37 publications

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Stratifying Stroke Risk in Atrial Fibrillation

Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA 2 DS 2 -VASc Score 1 in Men, 2 in Women) Be Anticoagulated?

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Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA ₂ DS ₂ -VASc Score 1 in Men, 2 in Women) Be Anticoagulated?