University of Ottawa Heart Institute, Ottawa, ON, Canada.
Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada.
BMC Cardiovasc Disord. 2021 Sep 16;21(1):445. doi: 10.1186/s12872-021-02254-5.
Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF).
The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation.
Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00).
We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies.
NCT00438113, registered February 21, 2007.
导管消融术是治疗心房颤动的一种既定疗法，但受到复发的限制；人们一直在努力寻找预测复发的生物标志物。我们在基质修饰联合强化血压控制治疗心房颤动试验（SMAC-AF）中，研究了基线 NT-proBNP 对接受积极（<120/80mmHg）或标准血压管理（<140/90mmHg）的随机分组患者导管消融后房颤复发的影响。
SMAC-AF 研究纳入了 173 名至少对一类 I 或 III 抗心律失常药物耐药或不耐受的患者。我们研究了基线 NT-proBNP 对消融后 3 个月以上房颤复发这一主要结局的影响。
在 173 名患者中，88 名被随机分配到积极组，85 名分到标准组。积极组中有 61.4%的患者发生主要结局，而标准组中有 61.2%。在积极组中，logNT-proBNP 预测了复发（HR 1.28，p=0.04，调整后的 HR 1.43，p=0.03），而在标准组中则不然（HR 0.94，p=0.62，调整后的 HR 0.83，p=0.22）。NT-proBNP≥280pg/ml 也能预测积极组中的发生（HR 1.98，p=0.02），但不能预测标准组（HR 1.00，p=1.00）。
我们得出结论，消融前 NT-proBNP 可能有助于预测高血压患者的复发，并识别从强化血压控制和上游治疗中获益的患者。
NCT00438113，于 2007 年 2 月 21 日注册。
