Zhang Yunhe, Chen Ao, Song Lei, Li Min, Chen Yingmin, He Ben
Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University.
Int Heart J. 2016;57(2):183-9. doi: 10.1536/ihj.15-355. Epub 2016 Mar 11.
Natriuretic peptides like B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro BNP) are reported to be increased in atrial fibrillation (AF) patients. However, the prognostic roles of BNP and NT-pro BNP in post-ablation AF recurrence remain inconclusive. We performed this meta-analysis to investigate the potential role of baseline natriuretic peptides in predicting AF recurrence after catheter ablation.Electronic databases were searched for studies that evaluated the potential relationship between AF recurrence and baseline BNP or NT-pro BNP levels. The pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to quantify differences in BNP or NT-pro BNP levels between patients with and without AF recurrence.Ten studies on BNP and 8 studies on NT-pro BNP were included, in which 411 of 1300 patients and 256 of 846 patients experienced AF recurrence, respectively. Overall, the pooled SMD of studies on BNP was 0.55 (95% CI: 0.260.84, P < 0.001) while the pooled SMD of studies on NT-pro BNP was 0.96 (95% CI: 0.62-1.30, P < 0.0001). Meta-regression was conducted by AF type, AF duration, follow-up period, left atrial dimension (LAD), and concomitant heart failure, after which subgroup analysis demonstrated only follow-up period (3 months or > 3 months) in the NT-pro BNP group might account for the heterogeneity. Sensitivity analyses indicated both the results were stable.Meta-analysis of current eligible studies suggested that both increased baseline BNP and NT-pro BNP levels are associated with greater risk of AF recurrence after catheter ablation, which could be biomarkers for predicting AF recurrence.
据报道,心房颤动(AF)患者体内的利钠肽如B型利钠肽(BNP)和N末端前脑钠肽(NT-pro BNP)会升高。然而,BNP和NT-pro BNP在消融术后房颤复发中的预后作用仍不明确。我们进行了这项荟萃分析,以研究基线利钠肽在预测导管消融术后房颤复发中的潜在作用。
通过电子数据库搜索评估房颤复发与基线BNP或NT-pro BNP水平之间潜在关系的研究。计算合并标准化均数差(SMD)和95%置信区间(CI),以量化有或无房颤复发患者之间BNP或NT-pro BNP水平的差异。
纳入了10项关于BNP的研究和8项关于NT-pro BNP的研究,其中1300例患者中有411例、846例患者中有256例分别出现房颤复发。总体而言,关于BNP的研究合并SMD为0.55(95%CI:0.26 - 0.84,P < 0.001),而关于NT-pro BNP的研究合并SMD为0.96(95%CI:0.62 - 1.30,P < 0.0001)。按房颤类型、房颤持续时间、随访期、左心房内径(LAD)和合并心力衰竭进行Meta回归,之后亚组分析表明,仅NT-pro BNP组的随访期(3个月或>3个月)可能是异质性的原因。敏感性分析表明结果均稳定。
对当前符合条件的研究进行荟萃分析表明,基线BNP和NT-pro BNP水平升高均与导管消融术后房颤复发风险增加相关,它们可能是预测房颤复发的生物标志物。