N-terminal pro-B-type natriuretic peptide predicts atrioventricular block risk: a prospective population-based cohort study

Background Mechanical stress is associated with myocardial interstitial fibrosis and electrophysiological impairment. N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) is a biomarker of pressure or volume overload. Purpose To investigate the association between NT-proBNP and the risk of atrioventricular (AV) block. Methods 50,331 participants from the UK Biobank cohort involved in the Pharma Proteomics Project with no history of AV block or cardiac implantable electronic devices were analyzed. The primary outcome was a composite of second-degree AV block, third-degree AV block, or AV block-related pacemaker implantation. Secondary outcomes included each component of the primary outcome. We estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) across quartiles of NT-proBNP using generalized propensity score weighting. Results The mean age was 57.3 years, and 45.9% were men. During the median 11.8-year follow-up, 352 primary outcomes occurred. The highest NT-proBNP quartile, relative to the lowest, was associated with a 2.13-fold higher risk of the primary outcome (HR: 2.13, 95% CI: 1.46–3.11). Among individual components of the primary outcome, the highest NT-proBNP quartile, relative to the lowest, was associated with a 2.49-fold higher risk of third-degree AV block (HR: 2.49, 95% CI: 1.50–4.15) and a 3.13-fold higher risk of AV block-related pacemaker implantation (HR: 3.13, 95% CI: 1.81–5.43). Associations were consistent when NT-proBNP was treated as a continuous variable and across subgroups. Higher NT-proBNP levels were associated with elevated LVEDV and QRS prolongation. Conclusions Higher NT-proBNP levels were associated with an increased risk of AV block, likely reflecting cardiac conduction vulnerability.Association of NT-proBNP With OutcomesNTproBNP & Elevated LVEDV or QRS Prolongation