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

Abstract

Abstract:

ObjectiveTo 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.MethodsThis 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.ResultsNew-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).ConclusionsSerum NT-proBNP level is of certain value in prediction of the new-onset AF in patients with ischemic heart failure.

Key words:N-terminal pro-brain natriuretic peptide,Heart failure with low ejection fraction,Ischemic cardiomyopathy,New-onset atrial fibrillation

CLC Number:

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.

Figures/Tables5

Table 1

Comparison of demographic and biochemical characteristics between patients with and without atrial fibrillation

Item	AF（+）（n=44）	AF（-）（n=76）	Pvalue
Age（years）	62.3±10.8	56.1±12.4	0.698
Male（%）	33.3	32.9	0.611
BMI（kg/m²）	29.1±5.2	30.9±5.1	0.205
CHA₂DS₂-VAS_Cscore	3	2	0.634
DM（%）	42.1	45.7	0.470
HT（%）	50.8	48.3	0.391
NYHA class（%）
Ⅱ	43.2	65.8	0.005
Ⅲ	50.0	30.3	0.021
Ⅳ	6.8	3.9	0.051
Drugs（%）
Beta Blocker	75.4	73.1	0.755
ACEI or ARB	81.1	83.5	0.346
MRA	46.3	52.4	1.001
Ivabradin	13.2	14.7	0.528
Dogoxin	11.7	9.5	0.563
Diuretic	33.8	35.2	0.877
SBP（mmHg）	117.5±20.8	122.4±25.1	0.340
DBP（mmHg）	67.3±12.9	72.2±14.8	0.109
Heart rate（beats/min）	72	69	0.993
Hemoglobin（g/L）	9.2	10.3	0.765
Creatinin（μmol/L）	118	107	0.437
eGFR[mL/(min·1.73 m²)]	55	62	0.494
ALT（U/L）	52	50	0.910
AST（U/L）	49	51	0.935

Table 1

Item	AF(+)（n=44）	AF(-)（n=76）	Pvalue
LVEDV(mm)	69.3±4.6	68.2±4.9	0.841
LVESV(mm)	59.8±3.8	58.9±5.1	0.918
Interventricular septal thickness（mm）	8	9	0.507
LVEF(%)	35.5±3.0	38.1±1.9	0.319
E/A	2.4±1.0	1.3±0.7	0.006
E/E’	20.3±12.0	8.7±4.1	0.001
PASP（mmHg）	54.4±9.2	33.0±4.5	<0.001
PCWP(mmHg)	20.1±4.4	12.0±4.7	<0.001
LAV(mL)	80.8±27.6	63.1±15.8	0.005
LAVI(ml/m²)	41.5±13.2	30.5±7.0	0.002

Table 2

Time	NT-proBNP (pg/mL）	Pvalue
0 mon	2571.3±403.6	1881.6±362.6	<0.001
6 mon	2612.9±577.0	2079.2±395.6	0.005
12 mon	2733.5±499.7	2201.4±411.3	0.007

Table 3

Figure 1

Parameter	NT-proBNP
E/A	0.444	<0.001
E/E’	0.486	<0.001
PASP	0.498	<0.001
PCWP	0.447	<0.001
LAV	0.445	<0.001
LAVI	0.475	<0.001

Table 4

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