NT‐proBNP is associated with mortality and adverse cardiac events in patients with atrial fibrillation presenting to the emergency department

Abstract

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia in the emergency department. The CHA2DS2‐VASc score helps to predict thromboembolic risk; however, the rate of other adverse cardiac events is more difficult to predict.HypothesisThe biomarker N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) has prognostic value in patients presenting to the emergency department with AF.MethodsDuring a 1.5‐year period, a prospective study was performed in consecutive patients presenting to the emergency department with AF on the presenting electrocardiogram. At baseline, NT‐proBNP was measured. The primary endpoints were all‐cause death and major adverse cardiac events (MACE: all‐cause mortality, myocardial infarction, or revascularization).ResultsA total of 355 patients were included (mean age, 71 years; 55% male). The median duration of follow‐up was 2 years. After adjustment for baseline variables, the logNT‐proBNP was independently correlated with death (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.18‐1.99) and MACE (HR: 1.27, 95% CI: 1.03‐1.58). After adjustment for baseline variables, a high NT‐proBNP value (>500 pmol/L) was independently correlated with death (HR: 2.26, 95% CI: 1.19‐4.28), and for MACE a trend was seen (HR: 1.67, 95% CI: 0.96‐2.91) compared with a low value (<250 pmol/L).ConclusionsIn patients presenting to the emergency department with AF, higher NT‐proBNP values are independently associated with an increased mortality and MACE. Therefore, this biomarker may be a useful prognostic marker in the management and treatment of these patients.

Association of natriuretic peptide and adverse outcomes in patients with atrial fibrillation: A meta‐analysis

“…Briefly, our initial literature searches yielded 997 records, 37 of which were retrieved for full‐text assessment. Finally, 10 studies 10‐19 were included in this meta‐analysis. Figure 1 describes the detailed process of study selection.…”

“…Seven studies 11‐17 reported the association between BNP/NT‐proBNP level and MACEs risk. As shown in Figure 5, a fixed‐effect model meta‐analysis indicated that the pooled RR of MACEs was 2.17(95% CI 1.89–2.49) for the highest versus the lowest group of BNP/NT‐proBNP level, without heterogeneity between studies ( I 2 = 0.0%, P = .529).…”

“…Abnormal BNP/NT‐proBNP level is correlated with the severity of left ventricular dysfunction 9 . A number of studies 10‐15 have reported the prognostic role of BNP/NT‐proBNP level in patients with AF. However, the association of elevated NT‐proBNP level with all‐cause mortality 11 or cardiovascular events 15 remained controversial.…”

“…A number of studies 10‐15 have reported the prognostic role of BNP/NT‐proBNP level in patients with AF. However, the association of elevated NT‐proBNP level with all‐cause mortality 11 or cardiovascular events 15 remained controversial. Meanwhile, risk estimates of their prognostic utility has varied significantly between studies.…”

The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure

“…Recent reports showed that the level of serum NT-ProBNP can be used to evaluate cardiac function in patients and provide a prognosis. 3,17) A combination of ACE inhibitor, β-blocker, and aldosterone antagonists without contraindications was recommended for patients of heart failure with reduced ejection fraction. 18) Even though patients with heart failure are treated with optimized ACEI, β-blocker, and aldosterone antagonists, almost 50% more cases of CHF are predicted by 2030.…”