Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.
ESC Heart Fail. 2022 Feb;9(1):100-109. doi: 10.1002/ehf2.13703. Epub 2021 Nov 30.
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP). It is known that AF impairs the diagnostic accuracy of NT-proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT-proBNP for HF and AF in stable outpatients with cardiovascular risk factors.
Data were obtained from the DIAST-CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population-based cohorts using the same inclusion/exclusion criteria: LIFE-Adult (n = 2869), SHIP (n = 2013), and SHIP-TREND (n = 2408). Serum levels of NT-proBNP were taken once at baseline. The DIAST-CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT-proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT-proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P < 0.001) and compared with those with only HF [n = 201; 158 (66;363) pg/mL; P < 0.001]. The highest levels of NT-proBNP [868 (213;1397) pg/mL] were measured in patients with concomitant HF and AF (n = 58; P < 0.001 vs. control and vs. HF, P = 1.0 vs. AF). In patients with AF, NT-proBNP levels did not differ between those with HF and preserved ejection fraction (EF) > 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver-operating characteristic curves of NT-proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79-0.88]) and for HF with EF < 50% (0.78 [0.72-0.85]; P = 0.18). The AUC for HF with EF > 50% was significantly lower (0.61 [0.56-0.65]) than for AF (P = 0.001). During follow-up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT-proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75-0.83]) than of newly diagnosed HF (0.59 [0.55-0.63]; P < 0.001). Data were validated in three independent population-based cohorts (LIFE-Adult, n = 2869; SHIP, n = 2013; and SHIP-TREND, n = 2408).
In stable outpatients, NT-proBNP is a better marker for prevalent and incident AF than for HF. In AF patients, the diagnostic value of NT-proBNP for HF with EF > 50% is very limited.
心力衰竭（HF）和心房颤动（AF）常同时存在，且两者均与 N 末端脑利钠肽前体（NT-proBNP）水平升高有关。已知 AF 会降低 NT-proBNP 对 HF 的诊断准确性。本研究旨在比较 NT-proBNP 对有心血管危险因素的稳定门诊患者 HF 和 AF 的诊断和预测准确性。
数据来自 DIAST-CHF 试验，这是一项前瞻性队列研究，纳入了有心血管危险因素的个体，并对其进行了 12 年的随访。使用相同的纳入/排除标准，在三个独立的基于人群的队列中对数据进行了验证：LIFE-Adult（n=2869）、SHIP（n=2013）和 SHIP-TREND（n=2408）。在基线时采集一次血清 NT-proBNP 水平。DIAST-CHF 研究共纳入 1727 名研究参与者（47.7%为女性，平均年龄 66.9±8.1 岁）。在无 AF 或 HF 的患者（n=1375）中，基线时 NT-proBNP 的中位数为 94pg/mL（四分位距 51；181）。在有 AF 的患者（n=93）中，NT-proBNP 为 667（215；1130）pg/mL。明显高于第一组（P<0.001），也高于仅 HF 的患者[n=201；158（66；363）pg/mL；P<0.001]。在同时患有 HF 和 AF 的患者（n=58）中，NT-proBNP 水平最高[868（213；1397）pg/mL；P<0.001 与对照组和 HF 组相比，P=1.0 与 AF 组相比]。在有 AF 的患者中，HF 伴射血分数（EF）>50%的患者[n=38；603（175；1070）pg/mL]与无 HF 的患者之间，NT-proBNP 水平无差异（P=1.0）。NT-proBNP 的受试者工作特征曲线显示，基线时对 AF 的检测，NT-proBNP 的曲线下面积（AUC）相似（0.84，95%CI [0.79-0.88]），HF 伴 EF<50%的 AUC 为 0.78 [0.72-0.85]；P=0.18）。HF 伴 EF>50%的 AUC 明显低于 AF 的 AUC（0.61 [0.56-0.65]；P=0.001）。在随访期间，157 名（9.1%）患者新诊断为 AF，141 名（9.6%）患者新诊断为 HF。在最初的 2 年内，NT-proBNP 是新发 AF 的更好预测指标（AUC：0.79 [0.75-0.83]），而不是新发 HF（AUC：0.59 [0.55-0.63]；P<0.001）。数据在三个独立的基于人群的队列中进行了验证（LIFE-Adult，n=2869；SHIP，n=2013；和 SHIP-TREND，n=2408）。
在稳定的门诊患者中，NT-proBNP 是 AF 现患和新发的更好标志物，而不是 HF。在 AF 患者中，NT-proBNP 对 EF>50%的 HF 的诊断价值非常有限。
