Key result
Elevated NT-proBNP identifies atrial fibrillation with ~85% diagnostic accuracy over sinus rhythm.
Why the study?
Although NT-proBNP is the gold-standard biomarker for congestive heart failure, its role in detecting atrial fibrillation is gaining attention and the influence of aberrant cardiac rhythms on plasma and noninvasive urinary NT-proBNP in acute chest pain required assessment.
Does plasma and urinary NT-proBNP discriminate atrial fibrillation and other aberrant cardiac rhythms from sinus rhythm in patients presenting with acute chest pain?
Observational (n=824)
No
Does plasma and urinary NT-proBNP discriminate atrial fibrillation and other aberrant cardiac rhythms from sinus rhythm in patients presenting with acute chest pain?
Both plasma and urinary NT-proBNP are significantly elevated in atrial fibrillation, atrial flutter, and right ventricular pacing independently of heart failure, supporting the need for rhythm-adjusted diagnostic thresholds and showing potential for urinary NT-proBNP as a noninvasive alternative.
Answers are grounded in this paper and cite their sources.
Standard NT-proBNP thresholds should be interpreted cautiously during AF in acute chest pain; leaves open optimal rhythm-specific diagnostic cutoffs pending prospective validation.
NT-proBNP is the gold-standard biomarker for diagnosing and monitoring congestive heart failure (CHF); however, its role in detecting atrial fibrillation (AFib) is gaining attention. This study assessed the influence of aberrant cardiac rhythms on plasma NT-proBNP (pNT) considering urinary NT-proBNP (uNT) as a noninvasive alternative in selected clinical scenarios. In 824 patients presenting with chest pain at the emergency department of the University Hospital of Regensburg, pNT was assessed. A subset of 355 patients additionally provided uNT. Both pNT and uNT were significantly increased in AFib, and lesser in atrial flutter (AFlut) and right ventricular (RV) pacing compared to SR (each p < 0.05). A pNT cutoff of 900 pg/mL yielded 74% sensitivity and 83% specificity for discriminating AFib from SR (AUC = 0.85). In multivariate regression, pNT or uNT and history of AFib were independent predictors of AFib (p < 0.05). Both pNT and uNT are significantly elevated in AFib, and to a lesser extent AFlut, and RV pacing independently of heart failure. These findings align with prior observations and provide further evidence supporting adequately powered prospective studies to evaluate rhythm-adjusted diagnostic thresholds for CHF in AFib. In addition, uNT may complement pNT when venous access is difficult or serial remote monitoring is required.
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Lang et al. (2026) conducted an observational in Acute chest pain with atrial fibrillation or other aberrant cardiac rhythms (n=824). Plasma and urinary NT-proBNP levels in atrial fibrillation, atrial flutter, and RV pacing vs. Sinus rhythm was evaluated on Discrimination of atrial fibrillation from sinus rhythm using plasma and urinary NT-proBNP (AUC 0.85, p=<0.05). Plasma and urinary NT-proBNP were significantly elevated in AFib vs sinus rhythm (p<0.05), with a 900 pg/mL plasma cutoff yielding 74% sensitivity and 83% specificity (AUC 0.85).
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