Key result
Elevated NT-proBNP and BNP detect silent paroxysmal AF during sinus rhythm with ~0.76 AUC.
Why the study?
Detection of paroxysmal atrial rhythm disorders is clinically challenging despite their relevance as precursors of ischaemic stroke.
Do elevated natriuretic peptide levels (NT-proBNP and BNP) detect paroxysmal atrial fibrillation/tachycardia in patients with cardiovascular risk factors or retinal vessel disease?
Observational (n=244)
Blinded to clinical data
Yes
Do elevated natriuretic peptide levels (NT-proBNP and BNP) detect paroxysmal atrial fibrillation/tachycardia in patients with cardiovascular risk factors or retinal vessel disease?
Effect estimate: AUC 0.76 (95% CI 0.64 to 0.88)
p-value: p=0.002
Elevated NT-proBNP and BNP levels are associated with silent paroxysmal AT/AF and may serve as a useful screening tool to initiate Holter monitoring for stroke prevention.
May support natriuretic peptide screening for silent PAF; leaves open prospective validation before practice change.
BACKGROUND AND PURPOSE: Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study. METHODS: Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF. RESULTS: 244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3-141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively. CONCLUSIONS: NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.
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Seegers et al. (2015) conducted an observational in Cardiovascular risk factors or retinal vessel disease (n=244). Natriuretic peptide levels (NT-proBNP and BNP) vs. Sinus rhythm (no paroxysmal AT/AF) was evaluated on Detection of paroxysmal AT/AF episodes (AUC 0.76, 95% CI 0.64 to 0.88, p=0.002). Elevated NT-proBNP and BNP levels effectively detected silent paroxysmal atrial fibrillation in patients presenting with sinus rhythm, yielding an area under the curve of 0.76 and 0.75, respectively.
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