Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, CIRCULATIONAHA.123.064361. https://doi.org/10.1161/CIRCULATIONAHA.123.064361 Dr. Lucas Yixi Xing et al.
Points
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of atrial fibrillation (AF) and stroke.
- A study was conducted on 6004 AF-naïve individuals aged 70-90 years with additional stroke risk factors to investigate NT-proBNP as a potential marker for AF screening efficacy and stroke prevention.
- Individuals with higher NT-proBNP levels had a higher risk of AF diagnosis and clinical events, including stroke or systemic embolism (SE), stroke/SE/cardiovascular death, and all-cause death.
- Implantable loop recorder (ILR) screening was associated with significant reductions in stroke/SE and stroke/SE/cardiovascular death among participants with higher NT-proBNP levels but not those with lower levels.
- Further investigation is needed before the clinical implementation of NT-proBNP as a marker for AF screening efficacy and stroke prevention in elderly individuals with additional stroke risk factors.
Summary
The study was conducted on a cohort of 6004 AF-naïve individuals aged 70-90, and 47.5% were females. The median NT-proBNP level was 15 pmol/L [interquartile range: 9-28], corresponding to 125 pg/mL [interquartile range: 76-233]. Participants with NT-proBNP above the median had a higher risk of AF diagnosis in both the ILR group (hazard ratio (HR) 1.84 [95% confidence interval (CI): 1.51-2.25]) and the Control group (HR 2.79 [95% CI: 2.30-3.40]).
Furthermore, participants with NT-proBNP above the median were at a significantly higher risk of clinical events, including stroke or systemic embolism (SE), stroke/SE/cardiovascular death, and all-cause death. Specifically, their hazard ratios were 1.21 [95% CI: 0.96-1.54] for stroke or SE, 1.60 [95% CI: 1.32-1.95] for stroke/SE/cardiovascular death, and 1.91 [95% CI: 1.61-2.26] for all-cause death.
Compared to usual care, ILR screening was associated with significant reductions in stroke/SE and stroke/SE/cardiovascular death among participants with NT-proBNP above the median. Specifically, their hazard ratios were 0.60 [95% CI: 0.40-0.90] for stroke/SE and 0.70 [95% CI: 0.53-0.94] for stroke/SE/cardiovascular death. However, there was no observed risk reduction in all-cause death in either NT-proBNP subgroup for ILR versus Control (pinteraction=0.68).
Therefore, the study highlights the potential utility of NT-proBNP as a marker for AF screening efficacy and stroke prevention in an elderly population with additional stroke risk factors. However, further investigation is needed before its clinical implementation.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064361
References Xing, L. Y., Diederichsen, S. Z., Højberg, S., Krieger, D. W., Graff, C., Frikke-Schmidt, R., Olesen, M. S., Brandes, A., Køber, L., Haugan, K. J., & Svendsen, J. H. (2023). Effects of systematic atrial fibrillation screening according to n-terminal pro-b-type natriuretic peptide: A secondary analysis of the randomized loop study. Circulation, CIRCULATIONAHA.123.064361. https://doi.org/10.1161/CIRCULATIONAHA.123.064361
