Liu Xiao, Chen Sixu, Pan Hong, Zhang Zenghui, Wang Yue, Jiang Yuan, Wu Maoxiong, Chen Zhiteng, Abudukeremu Ayiguli, Cao Zhengyu, Gao Qingyuan, Zhang Minghai, Zhu Wengen, Chen Yangxin, Zhang Yuling, Wang Jingfeng
Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China.
ESC Heart Fail. 2024 Dec;11(6):4296-4307. doi: 10.1002/ehf2.14951. Epub 2024 Aug 28.
The prognostic significance of N-terminal pro B-type natriuretic peptide (NT-proBNP) in heart failure with preserved ejection fraction (HFpEF) has been well established. HFpEF and atrial fibrillation (AF) commonly coexist, and each contributes to poor outcomes independently. Nevertheless, the ability of NT-proBNP to predict AF in HFpEF patients remains uncertain.
A total of 367 HFpEF patients without baseline AF from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included. The Cox proportional hazard model was used to assess the association of NT-proBNP with the risk of AF. The C-statistic, categorical net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the ability of NT-proBNP in new-onset AF prediction. During a median follow-up of 2.91 years, 17 (4.63%) new-onset AF cases occurred. Every 1000 pg/mL increase in NT-proBNP was associated with a 16% increase in the risk of AF occurrence after adjustments (hazard ratio, 1.16 [95% CI, 1.02-1.32]). NT-proBNP showed a moderate performance for new-onset AF at 3 years (C-statistic, 0.67). Adding NT-proBNP to CHADS/RCHADS/CHADS-VASc/CHSET scores improved their predictive performance for AF risk (CHADS: C-statistic, 0.63, CHADS+NT: C-statistic, 0.69, NRI, 47.46%, IDI, 1.18%; RCHADS: C-statistic, 0.65, RCHADS+NT: C-statistic, 0.70, NRI, 48.03%, IDI, 0.51%; CHADS-VASc: C-statistic, 0.67, CHADS-VASc+NT: C-statistic, 0.72, NRI, 49.41%, IDI, 0.86%; CHSET: C-statistic, 0.77, CHSET+NT: C-statistic, 0.80, NRI, 50.32%, IDI, 1.58%).
Among patients with HFpEF, the NT-proBNP level was positively associated with the incidence of new-onset AF and may be a promising predictor.
N末端B型利钠肽原（NT-proBNP）在射血分数保留的心力衰竭（HFpEF）中的预后意义已得到充分证实。HFpEF和心房颤动（AF）常同时存在，且各自独立导致不良预后。然而，NT-proBNP预测HFpEF患者发生AF的能力仍不确定。
醛固酮拮抗剂治疗射血分数保留的心力衰竭（TOPCAT）试验中，共纳入367例无基线AF的HFpEF患者。采用Cox比例风险模型评估NT-proBNP与AF风险的相关性。使用C统计量、分类净重新分类指数（NRI）和综合判别改善（IDI）评估NT-proBNP预测新发AF的能力。在中位随访2.91年期间，发生17例（4.63%）新发AF病例。调整后，NT-proBNP每增加1000 pg/mL，AF发生风险增加16%（风险比，1.16[95%CI，1.02 - 1.32]）。NT-proBNP对3年新发AF的预测表现中等（C统计量，0.67）。将NT-proBNP加入CHADS/RCHADS/CHADS-VASc/CHSET评分中，可提高其对AF风险的预测性能（CHADS：C统计量，0.63，CHADS + NT：C统计量，0.69，NRI，47.46%，IDI，1.18%；RCHADS：C统计量，0.65，RCHADS + NT：C统计量，0.70，NRI，48.03%，IDI，0.51%；CHADS-VASc：C统计量，0.67，CHADS-VASc + NT：C统计量，0.72，NRI，49.41%，IDI，0.86%；CHSET：C统计量，0.77，CHSET + NT：C统计量，0.80，NRI，50.32%，IDI，1.58%）。
在HFpEF患者中，NT-proBNP水平与新发AF的发生率呈正相关，可能是一个有前景的预测指标。
