Original articles

Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure

  • LUO Xiaoying ,
  • ZHANG Andi ,
  • XU Yan ,
  • WU Liqun ,
  • QI Wenhang
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  • Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2024-04-01

  Accepted date: 2024-05-15

  Online published: 2024-06-25

Abstract

Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P<0.05). NT-proBNP levels demonstrated positive correlations with these echocardiographic parameters (P<0.05). ROC curve analysis identified a baseline NT-proBNP cutoff value of 2357 pg/mL as the most predictive of new-onset AF, with 69% sensitivity and 83% specificity (AUC = 0.825, 95% CI: 0.722-0.924, P<0.001). Logistic regression analysis further established NT-proBNP as the only independent predictive predictor of new-onset AF (OR = 1.24, 95% CI: 1.08-1.43, P=0.001). Conclusions Serum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.

Cite this article

LUO Xiaoying , ZHANG Andi , XU Yan , WU Liqun , QI Wenhang . Association between NT-proBNP and new-onset atrial fibrillation in patients with ischemic heart failure[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(03) : 313 -317 . DOI: 10.16150/j.1671-2870.2024.03.009

References

[1] BERGAU L, BENGEL P, SCIACCA V, et al. Atrial fibrillation and heart failure[J]. J Clin Med, 2022, 11(9):2510.
[2] KARNIK A A, GOPAL D M, KO D, et al. Epidemiology of atrial fibrillation and heart failure: a growing and important problem[J]. Cardiol Clin, 2019, 37(2):119-129.
[3] ARIYARATNAM J P, LAU D H, SANDERS P, et al. Atrial fibrillation and heart failure: epidemiology, pathophysiology, prognosis, and management[J]. Card Electrophysiol Clin, 2021, 13(1):47-62.
[4] CHANG H Y, FENG A N, FONG M C, et al. Managements and outcomes of hospitalized heart failure patients with paroxysmal vs nonparoxysmal atrial fibrillation in Taiwan[J]. J Chin Med Assoc, 2019, 82(5):356-362.
[5] WERHAHN S M, BECKER C, MENDE M, et al. NT-proBNP as a marker for atrial fibrillation and heart fai-lure in four observational outpatient trials[J]. ESC Heart Fail, 2022, 9(1):100-109.
[6] CHOUAIRI F, PACOR J, MILLER P E, et al. Effects of atrial fibrillation on heart failure outcomes and NT-proBNP levels in the GUIDE-IT trial[J]. Mayo Clin Proc Innov Qual Outcomes, 2021, 5(2):447-455.
[7] BRADY P F, CHUA W, NEHAJ F, et al. Interactions between atrial fibrillation and natriuretic peptide in predicting heart failure hospitalization or cardiovascular death[J]. J Am Heart Assoc, 2022, 11(4):e022833.
[8] Z?GREANU V M, POP D, ZDRENGHEA M, et al. Plasmatic levels of N-terminal pro-BNP in elderly patients with atrial fibrillation and heart failure with preserved ejection fraction[J]. Iran J Public Health, 2017, 46(4):568-570.
[9] KIUCHI K, SHIRAKABE A, KOBAYASHI N, et al. Prognostic impact of new-onset atrial fibrillation associated with worsening heart failure in aging patients with severely decompensated acute heart failure[J]. Int J Cardiol, 2020, 302:88-94.
[10] NAGUEH S F, MIDDLEERON K J, KOPELEN H A, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressure[J]. J Am Coll Cardiol, 1997, 30(6):1527-1533.
[11] BELTRAMI M, DEI L L, MILLI M. The role of the left atrium: from multimodality imaging to clinical practice: a review[J]. Life (Basel), 2022, 12(8):1191.
[12] TSUCHIDA K, TANABE K. Influence of paroxysmal atrial fibrillation attack on brain natriuretic peptide secretion[J]. J Cardiol, 2004, 44(1):1-11.
[13] INOUE N, ISHIKAWA T, SUMITA S, et al. Suppression of atrial fibrillation by atrial pacing[J]. Circ J, 2006, 70(11):1398-1401.
[14] 高艳, 刘悦, 叶斌. 年龄 房颤 舒张压对急性缺血性脑卒中rt-PA静脉溶栓后出血转化的影响[J]. 安徽医学, 2023, 44(3):245-251.
  GAO Y, LIU Y, YE B. Influence of age atrial fibrillation and diastolic pressure on hemorrhage transformation after intravenous thrombolysis with RT-PA in acute ischemic stroke[J]. Anhui Med, 2023, 44(3):245-251.
[15] 鲁锋, 侯杰, 李宝同, 等. 乳脂球表皮生长因子-8在心房颤动中的临床应用[J]. 中国临床研究, 2023, 36(2):263-265,270.
  LU F, HOU J, LI B T, et al. Clinical application of milk fat globule-epidermal growth factor 8 in atrial fibrillation[J]. Chin J Clin Res, 2023, 36(2):263-270.
[16] 蒲振业, 李鸿雁, 何伟, 等. 不停跳冠状动脉旁路移植术后发生房颤的影响因素[J]. 中国临床研究, 2022, 35(8):1055-1058.
  PU Z Y, LI H Y, HE W, et al. Influencing factors of atrial fibrillation after off-pump coronary artery bypass grafting[J]. Chin J Clin Res, 2022, 35(8):1055-1058.
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