Baseline adropin levels ≤2.95 ng/mL independently predicted new-onset atrial fibrillation over 3 years in patients with HFpEF, offering superior predictive value to NT-proBNP alone.
Cohort (n=953)
Low baseline adropin levels (≤2.95 ng/mL) independently predict new-onset atrial fibrillation in patients with HFpEF, offering superior discriminative value compared to NT-proBNP.
Abstract Background Atrial fibrillation (AF) is common complication of heart failure with preserved ejection fraction (HFpEF) that sufficiently intervenes in the prognosis. The aim of the study is a) to investigate the possible discriminative value of adropin for newly onset AF in patients with HFpEF without a previous history of AF and who are being treated in accordance with conventional guideline and b) to compare it with predictive potencies of conventionally used predictors. Methods A total of 953 patients with HFpEF who had the following criteria: left ventricular (LV) ejection fraction (EF) 50%; abnormal LV global longitudinal strain (GLS) -16%, LV myocardial mass index (MMI) ≥95 g/m2 in women or ≥115 g/m2 in men, left atrial volume index (LAVI) 34 mL/m2, and ab-normal diastolic index E/e’ ≥ 13 units, N-terminal natriuretic pro-peptide (NT-proBNP) ≥ 300 pmol/mL, and sinus rhythm on ECG were enrolled in the study. All patients continued to receive optimal GDMT and provided voluntary written in-formed consent to participate in the study (Figure 1). The course of the observation was 3 years. Echocardiography and assessment of conventional hematological, biochemical parameters and biomarker assay including N-terminal brain natriuretic pro-peptide (NT-proBNP), high-sensitivity cardiac troponin T, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), galectin-3, interleukin-6, soluble suppressor tumorigenisity-2 (sST2) and adropin, were performed at baseline. Results Incident atrial fibrillation was found in 172 patients with HFpEF, whereas 781 had sinus rhythm. ROC curve analysis was performed to determine the optimal cutoff for possible predictors of new onset AF in patients with HFpEF (Figure 2). In unadjusted rough Cox regression model, age ≥ 75 years, type 2 diabetes mellitus, chronic kidney disease (CKD) stages 1–3, left atrial volume index (LAVI) ≥40 mL/m2, NT-proBNP ≥1440 pmol/mL, hs-CRP ≥5.40 mg/L, adropin ≤2.95 ng/mL, sST2 ≥15.5 ng/mL were identified as the predictors for new onset AF in HFpEF patients. After adjusting for age ≥ 75 years, a presence of type 2 diabetes mellitus and CKD stages 1–3, the levels of NT-proBNP ≥1440 pmol/mL and adropin ≤2.95 ng/mL were independent predictors of new onset AF in patients HFpEF. We also found that discriminative value of adropin was superior to NT-proBNP, while adding adropin to NT-proBNP did not improve predictive information of adropin alone. Conclusions adropin ≤2.95 ng/mL presented more predictive information than NT-proBNP ≥1440 pmol/mL alone for new cases of AF in symptomatic patients with HFpEF, whereas the combination of both biomarkers did not improve the predictive ability of adropin alone.Flow chart and study designFor image description, please refer to the figure legend and surrounding text. ROC curvesFor image description, please refer to the figure legend and surrounding text.
Berezin et al. (Mon,) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=953). Adropin ≤2.95 ng/mL vs. Adropin >2.95 ng/mL was evaluated on New onset atrial fibrillation. Baseline adropin levels ≤2.95 ng/mL independently predicted new-onset atrial fibrillation over 3 years in patients with HFpEF, offering superior predictive value to NT-proBNP alone.