In stable outpatients with cardiovascular risk factors, NT-proBNP was a significantly better diagnostic marker for detecting atrial fibrillation (AUC 0.84) than for heart failure with preserved ejection fraction (AUC 0.61).
Observational (n=1,727)
Single-blind
Yes
Does baseline NT-proBNP accurately diagnose and predict atrial fibrillation compared to heart failure in stable outpatients with cardiovascular risk factors?
In stable outpatients, NT-proBNP is a stronger diagnostic and predictive marker for atrial fibrillation than for heart failure, and its diagnostic utility for HFpEF is severely limited in the presence of AF.
Effect estimate: AUC 0.84 (95% CI 0.79-0.88)
Absolute Event Rate: 0.84% vs 0.61%
p-value: p=0.001
AIMS: 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. METHODS AND RESULTS: 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 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% 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 50% is very limited.
Werhahn et al. (Tue,) conducted a observational in Atrial fibrillation and Heart failure (n=1,727). NT-proBNP measurement vs. Heart failure with preserved ejection fraction (HFpEF) was evaluated on Diagnostic accuracy (AUC) for detection of atrial fibrillation at baseline (AUC 0.84, 95% CI 0.79-0.88, p=0.001). In stable outpatients with cardiovascular risk factors, NT-proBNP was a significantly better diagnostic marker for detecting atrial fibrillation (AUC 0.84) than for heart failure with preserved ejection fraction (AUC 0.61).
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