Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.
Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK.
J Am Heart Assoc. 2022 Feb 15;11(4):e022833. doi: 10.1161/JAHA.121.022833. Epub 2022 Feb 3.
Background Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their value in predicting future cardiovascular events, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and outcomes. Methods and Results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital underwent clinical assessment, 7-day ECG monitoring, and echocardiography to diagnose AF and HF. NT-proBNP (N-terminal pro-B-type natriuretic peptide) was centrally quantified. Based on a literature review, four NT-proBNP groups were defined (<300, 300-999, 1000-1999, and ≥2000 pg/mL). Clinical characteristics and NT-proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow-up data were available in 1616 of 1621 patients (99.7%) and analysis performed at 2.5 years (median age, 70 [interquartile range, 60-78] years; 40% women). HF hospitalization or cardiovascular death increased from 36 of 488 (3.2/100 person-years) in patients with neither AF nor HF, to 55 of 354 (7.1/100 person-years) in patients with AF only, 92 of 369 (12.1/100 person-years) in patients with HF only, and 128 of 405 (17.7/100 person-years) in patients with AF plus HF (<0.001). Higher NT-proBNP concentrations predicted the outcome in patients with AF only (C-statistic, 0.82; 95% CI, 0.77-0.86; <0.001) and in other phenotype groups (C-statistic in AF plus HF, 0.66; [95% CI, 0.61-0.70]; <0.001). Conclusions Elevated NT-proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF, encouraging routine quantification of NT-proBNP in the assessment of patients with AF.
背景 利钠肽通常用于诊断心力衰竭（HF）。心房颤动（AF）时其浓度也会升高。为了阐明其在预测未来心血管事件中的价值，我们测量了心血管疾病患者的利钠肽浓度，并将其与 AF 和 HF 状态和结局相关联。
方法和结果 连续就诊于大型教学医院的心血管疾病患者接受了临床评估、7 天心电图监测和超声心动图检查以诊断 AF 和 HF。NT-proBNP（N 末端 pro-B 型利钠肽）被集中定量。基于文献回顾，将 4 个 NT-proBNP 组定义为（<300，300-999，1000-1999 和≥2000pg/mL）。临床特征和 NT-proBNP 浓度与 HF 住院或心血管死亡相关。1621 例患者中的 1616 例（99.7%）有随访数据，分析时间为 2.5 年（中位年龄 70 岁[四分位距 60-78 岁]；40%为女性）。HF 住院或心血管死亡从无 AF 且无 HF 的 488 例患者中的 36 例（3.2/100 人年）增加到仅 AF 的 354 例患者中的 55 例（7.1/100 人年）、仅 HF 的 369 例患者中的 92 例（12.1/100 人年）和 AF 加 HF 的 405 例患者中的 128 例（17.7/100 人年）（<0.001）。较高的 NT-proBNP 浓度预测了仅 AF 患者的结局（C 统计量为 0.82；95%CI，0.77-0.86；<0.001）和其他表型组的结局（AF 加 HF 的 C 统计量为 0.66[95%CI，0.61-0.70]；<0.001）。
结论 在 AF 患者中，升高的 NT-proBNP 浓度可预测未来的 HF 事件，无论是否存在 HF，均鼓励常规定量检测 NT-proBNP 以评估 AF 患者。
