Natriuretic peptides: biomarkers for atrial fibrillation management

Shamloo, Alireza Sepehri; Bollmann, Andreas; Dagres, Nikolaos; Hindricks, Gerhard; Arya, Arash

doi:10.1007/s00392-020-01608-x

Cited by 23 publications

(10 citation statements)

References 83 publications

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“…Opposed to findings in previous studies, our study showed that increased NT-proBNP levels did not seem useful as a selection parameter for extended AF screening. 22 The optimal cut-off value differed across these studies, but even a comparison of assumed low and high risk values as previously suggested 23 showed no significant association to AF in the present study. A lack of power for this secondary endpoint may explain our finding.…”

Section: Discussioncontrasting

confidence: 56%

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Lyckhage

Hansen

Toft

et al. 2020

Heart

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Background and purposeThe diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.MethodsPatients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.Results7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14–37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).ConclusionsA relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.

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Section: Discussioncontrasting

confidence: 56%

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Lyckhage

Hansen

Toft

et al. 2020

Heart

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“…Therefore, special emphasis should also be placed on adequate diagnostic measures and revascularization strategies. Additionally, atrial fibrillation (AF), the most common arrhythmia, often coexists with HFpEF [46]. According to a post hoc analysis of the TOPCAT trial, detection of AF represents an independent risk factor of adverse cardiovascular (CV) outcome (composite endpoint of CV mortality, aborted cardiac arrest, or HF hospitalization) [47].…”

Section: Focus On Comorbiditiesmentioning

confidence: 99%

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

et al. 2020

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In contrast to the wealth of proven therapies for heart failure with reduced ejection fraction (HFrEF), therapeutic efforts in the past have failed to improve outcomes in heart failure with preserved ejection fraction (HFpEF). Moreover, to this day, diagnosis of HFpEF remains controversial. However, there is growing appreciation that HFpEF represents a heterogeneous syndrome with various phenotypes and comorbidities which are hardly to differentiate solely by LVEF and might benefit from individually tailored approaches. These hypotheses are supported by the recently presented PARAGON-HF trial. Although treatment with LCZ696 did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among HFpEF patients, subanalyses suggest beneficial effects in female patients and those with an LVEF between 45 and 57%. In the future, prospective randomized trials should focus on dedicated, well-defined subgroups based on various information such as clinical characteristics, biomarker levels, and imaging modalities. These could clarify the role of LCZ696 in selected individuals. Furthermore, sodium-glucose cotransporter-2 inhibitors have just proven efficient in HFrEF patients and are currently also studied in large prospective clinical trials enrolling HFpEF patients. In addition, several novel disease-modifying drugs that pursue different strategies such as targeting cardiac inflammation and fibrosis have delivered preliminary optimistic results and are subject of further research. Moreover, innovative device therapies may enhance management of HFpEF, but need prospective adequately powered clinical trials to confirm safety and efficacy regarding clinical outcomes. This review highlights the past, present, and future therapeutic approaches in HFpEF.

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“…These results suggest a potential improvement in the predictive value of apelin when incorporate into a multi-factor scoring system. The potential benefit of multi-factorial biomarker-based prediction models has already been described in several studies (36,46,47).…”

Section: Discussionmentioning

confidence: 95%

Association Between Apelin and Atrial Fibrillation in Patients With High Risk of Ischemic Stroke

Böhm

Snopek

Tóthová

et al. 2021

Front. Cardiovasc. Med.

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Background: Atrial fibrillation (AF) is associated with high risk of stroke preventable by timely initiation of anticoagulation. Currently available screening tools based on ECG are not optimal due to inconvenience and high costs. Aim of this study was to study the diagnostic value of apelin for AF in patients with high risk of stroke.Methods: We designed a multicenter, matched-cohort study. The population consisted of three study groups: a healthy control group (34 patients) and two matched groups of 60 patients with high risk of stroke (AF and non-AF group). Apelin levels were examined from peripheral blood.Results: Apelin was significantly lower in AF group compared to non-AF group (0.694 ± 0.148 vs. 0.975 ± 0.458 ng/ml, p = 0.001) and control group (0.982 ± 0.060 ng/ml, p < 0.001), respectively. Receiver operating characteristic (ROC) analysis of apelin as a predictor of AF scored area under the curve (AUC) of 0.658. Apelin's concentration of 0.969 [ng/ml] had sensitivity = 0.966 and specificity = 0.467. Logistic regression based on manual feature selection showed that only apelin and NT-proBNP were independent predictors of AF. Logistic regression based on selection from bivariate analysis showed that only apelin was an independent predictor of AF. A logistic regression model using repeated stratified K-Fold cross-validation strategy scored an AUC of 0.725 ± 0.131.Conclusions: Our results suggest that apelin might be used to rule out AF in patients with high risk of stroke.

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Natriuretic peptides: biomarkers for atrial fibrillation management

Cited by 23 publications

References 83 publications

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Therapeutic approaches in heart failure with preserved ejection fraction: past, present, and future

Association Between Apelin and Atrial Fibrillation in Patients With High Risk of Ischemic Stroke

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