Key result
In patients with heart failure, NT-proBNP levels are significantly elevated by the presence of underlying atrial fibrillation at the time of measurement, whereas GDF-15 levels remain unaffected.
Why the study?
Concomitant AF influences NT-proBNP levels in heart failure, complicating diagnosis, but whether GDF-15 levels are similarly affected by AF is unknown.
Does concomitant atrial fibrillation influence the levels of NT-proBNP and GDF-15 in patients with heart failure?
Observational (n=4,254)
Yes
Does concomitant atrial fibrillation influence the levels of NT-proBNP and GDF-15 in patients with heart failure?
Absolute Event Rate: 3417% vs 2231%
p-value: p=<0.001
In patients with heart failure, NT-proBNP levels are significantly elevated by the presence of concomitant atrial fibrillation, whereas GDF-15 levels are not, suggesting GDF-15 may be a more reliable biomarker for HF severity in patients with AF.
Caution advised interpreting NT-proBNP in HF with AF; leaves open GDF-15 as rhythm-independent severity marker.
BACKGROUND: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). METHODS: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). RESULTS: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th-75th percentile 1897-6486] versus 1788 [682-3870], adjusted p < 0.001, versus 2231 pg/mL [902-5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062-5253] versus 2545 [1686-4337], adjusted p = 0.36, versus 2294 [1471-3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. CONCLUSION: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.
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Santema et al. (2019) conducted an observational in Heart failure (n=4,254). Atrial fibrillation at baseline vs. Sinus rhythm (with or without history of atrial fibrillation) was evaluated on Plasma NT-proBNP levels (pg/mL) (p=<0.001). In patients with heart failure, NT-proBNP levels are significantly elevated by the presence of underlying atrial fibrillation at the time of measurement, whereas GDF-15 levels remain unaffected.
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