Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden.
Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Heart. 2017 Aug;103(16):1271-1277. doi: 10.1136/heartjnl-2016-310236. Epub 2017 Mar 2.
Screening for atrial fibrillation (AF) in individuals aged 65 and above is recommended by the European Society of Cardiology. Increased levels of the biomarker N-terminal pro B-type natriuretic peptide (NT-proBNP) has in cohort studies been associated with incident AF.The aim of this study was to assess whether NT-proBNP could be useful for AF detection in systematic screening.
The Strokestop study entailed 7173 Swedish residents aged 75/76 that were screened for AF using twice daily intermittent ECG recordings during 2 weeks. In a substudy of 886 participants, the last 815 consecutive participants and 71 individuals with newly detected AF, levels of NT-proBNP were determined.
Participants with newly detected AF (n=96) had a median NT-proBNP of 330 ng/L (IQR 121;634). In individuals without AF (n=742), median NT-proBNP was 171 ng/L (IQR 95;283), p<0.001. The CHADS-VASc parameters did not differ significantly between individuals with newly detected AF and without AF nor between newly detected AF in the NT-proBNP cohort compared with the cohort where NT-proBNP was not assessed. Using an NT-proBNP cut-off of ≥125 ng/L in a non-acute setting yielded a negative predictive value of 92%, meaning that 35% fewer participants would need to be screened when applied to systematic AF screening. Adding weight to NT-proBNP further reduced participants needed to be screened with a preserved sensitivity.
NT-proBNP was increased in individuals with newly detected AF. Prospective studies could clarify if NT-proBNP can be used to correctly select individuals that benefit most from AF screening.
ClinicalTrials.gov. Identifier: NCT01593553.
欧洲心脏病学会建议对 65 岁及以上人群进行心房颤动（AF）筛查。队列研究表明，生物标志物 N 末端 pro B 型利钠肽（NT-proBNP）水平升高与 AF 事件相关。本研究旨在评估 NT-proBNP 是否可用于系统筛查中的 AF 检测。
Strokestop 研究纳入了 7173 名年龄为 75/76 岁的瑞典居民，通过两周内每天两次间歇性心电图记录进行 AF 筛查。在 886 名参与者的子研究中，测定了最后 815 名连续参与者和 71 名新发现 AF 患者的 NT-proBNP 水平。
新发现 AF 的患者（n=96）的 NT-proBNP 中位数为 330ng/L（IQR 121；634）。在无 AF 的患者（n=742）中，NT-proBNP 中位数为 171ng/L（IQR 95；283），p<0.001。新发 AF 患者和无 AF 患者的 CHADS-VASc 参数无显著差异，在新发现 AF 的 NT-proBNP 队列与未评估 NT-proBNP 的队列之间也无显著差异。在非急性情况下，使用 NT-proBNP 截断值≥125ng/L 时，阴性预测值为 92%，这意味着系统 AF 筛查时，需要筛查的参与者减少 35%。进一步增加 NT-proBNP 的权重可减少需要筛查的参与者，同时保持敏感性。
新发现 AF 的患者 NT-proBNP 升高。前瞻性研究可以明确 NT-proBNP 是否可用于正确选择最受益于 AF 筛查的患者。
ClinicalTrials.gov。标识符：NCT01593553。
