Al-Khalili Faris, Kemp-Gudmundsdottir Katrin, Svennberg Emma, Fredriksson Tove, Frykman Viveka, Friberg Leif, Rosenqvist Mårten, Engdahl Johan
Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Heart, Lung and Allergy Clinic, Sophiahemmet Hospital, Stockholm, Sweden.
Open Heart. 2020 Feb 19;7(1):e001200. doi: 10.1136/openhrt-2019-001200. eCollection 2020.
High plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) indicate increased probability of congestive heart failure (CHF) and atrial fibrillation (AF) and are associated with poor prognosis.
We aimed to describe the clinical and echocardiographic characteristics of a population of individuals aged 75/76 years old with NT-proBNP ≥900 ng/L without previously known CHF or AF.
All individuals aged 75/76 years in the Stockholm region were randomised to a screening study for AF. Half of them were invited to screening. Of those invited, 49.5% agreed to participate. Individuals with NT-proBNP ≥900 ng/L without known CHF were invited for further clinical evaluation.
Among 6315 participants without AF who had NT-proBNP sampled, 102 without previously known CHF had ≥900 ng/L. Of these, 93 completed further clinical investigations. In the population that was clinically investigated, 53% were female, and the median NT-proBNP was 1200 ng/L. New AF was found in 28 (30%). The NT-proBNP value in this group was not significantly different from those where AF was not detected (median 1285 vs 1178 ng/L). Patients with newly detected AF had larger left atrial volume and higher pulmonary artery pressure than those without AF. Preserved left ventricular ejection fraction (≥50%) was found in 86% of the participants, mid-range ejection fraction (40%-49%) in 3.2% and reduced ejection fraction (<40%) in 10.8%. Thirteen patients (14%) had other serious cardiac disorders that required medical attention.
Elderly individuals with NT-proBNP levels ≥900 ng/L constitute a population at high cardiovascular risk even in the absence of diagnosed CHF or AF, and therefore merit further investigation.
血浆N末端B型利钠肽原（NT-proBNP）水平升高表明充血性心力衰竭（CHF）和心房颤动（AF）的发生概率增加，且与预后不良相关。
我们旨在描述年龄在75/76岁、NT-proBNP≥900 ng/L且既往无CHF或AF的人群的临床和超声心动图特征。
斯德哥尔摩地区所有75/76岁的个体被随机分配到一项AF筛查研究中。其中一半被邀请进行筛查。在被邀请者中，49.5%同意参与。NT-proBNP≥900 ng/L且无已知CHF的个体被邀请进行进一步的临床评估。
在6315名未患AF且检测了NT-proBNP的参与者中，102名既往无CHF的个体NT-proBNP≥900 ng/L。其中，93名完成了进一步的临床检查。在接受临床检查的人群中，53%为女性，NT-proBNP中位数为1200 ng/L。新发现AF的有28例（30%）。该组的NT-proBNP值与未检测到AF的组无显著差异（中位数分别为1285和1178 ng/L）。新发现AF的患者比未患AF的患者左心房容积更大，肺动脉压力更高。86%的参与者左心室射血分数保留（≥50%），3.2%为中等射血分数（40%-49%），10.8%为射血分数降低（<40%）。13名患者（14%）患有其他需要医疗关注的严重心脏疾病。
NT-proBNP水平≥900 ng/L的老年人即使在未诊断出CHF或AF的情况下也属于心血管高风险人群，因此值得进一步研究。
