Plasma B-type Natriuretic Peptide as a Predictor of Cardiovascular Events in Subjects with Atrial Fibrillation: A Community-Based Study

Abstract

ObjectivesAtrial fibrillation (AF) is a significant public health issue due to its high prevalence in the general population, and is associated with an increased risk of cardiovascular (CV) events including systemic thrombo-embolism, heart failure, and coronary artery disease. The relationship between plasma B-type natriuretic peptide (BNP) and CV risk in real world AF subjects remains unknown.MethodsThe subject of the study (n = 228; mean age = 69 years) was unselected individuals with AF in a community-based population (n = 15,394; AF prevalence rate = 1.5%). The CV event free rate within each BNP tertile was estimated, and Cox regression analysis was performed to examine the relative risk of the onset of CV events among the tertiles. The prognostic ability of BNP was compared to an established risk score for embolic events (CHADS2 score). In addition, to determine the usefulness of BNP as a predictor in addition to CHADS2 score, we calculated Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices. ResultsDuring the follow-up period 58 subjects experienced CV events (52 per 1,000 person-years). The event-free ratio was significantly lower in the highest tertile (p < 0.02). After adjustment for established CV risk factors, the hazard ratio (HR) of the highest tertile was significantly higher than that of the lowest tertile (HR = 2.38; p < 0.02). The predictive abilities of plasma BNP in terms of sensitivity and specificity for general CV events were comparable to those of CHADS2 score. Adding BNP to the CHADS2 score only model improved the NRI (0.319; p < 0.05) and the IDI (0.046; p < 0.05). ConclusionPlasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general CV risk including stroke, heart failure and acute coronary syndrome in real-world AF subjects.

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

“…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.…”

Doppler myocardial performance index combined with plasma B-type natriuretic peptide levels as a marker of cardiac function in patients with decompensated cirrhosis

“…[13] BNP is cardiac hormone secreted by cardiomyocytes in the heart ventricles in response to increased cardiac wall stress caused by increased ventricular blood volume. [14] It has natriuretic, diuretic, and vasodilator actions regulating volume homeostasis and blood pressure. [15] Furthermore, BNP levels are accompanied with degree of left ventricle (LV) hypertrophy, LV outflow gradient, LV diastolic dysfunction, and LV systolic impairment.…”

Impact of B-type natriuretic peptide level on the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation: a prospective study

“…Moreover, BNP has also been shown to predict future AF [ 23 , 24 ] and risk of thromboembolism [ 13 , 25 ]. Recent studies have shown BNP to be a valuable marker for general cardiovascular risk stratification in patients with NVAF [ 26 ]. Pathophysiologically, increased LV filling pressure causes atrial stretch, which is a well-known reason for development of NVAF [ 27 ].…”