Key result
Plasma NT-proBNP discriminates atrial fibrillation from sinus rhythm with ~0.85 AUC.
Why the study?
Although NT-proBNP is the gold-standard biomarker for congestive heart failure, its role in detecting atrial fibrillation is gaining attention. This study evaluated how aberrant cardiac rhythms influence plasma NT-proBNP and assessed urinary NT-proBNP as a noninvasive alternative.
Does plasma and urinary NT-proBNP measurement discriminate atrial fibrillation from sinus rhythm in patients presenting with acute chest pain?
Observational (n=824)
No
Does plasma and urinary NT-proBNP measurement discriminate atrial fibrillation 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 RV pacing independently of heart failure, supporting the need for rhythm-adjusted diagnostic thresholds and highlighting urinary NT-proBNP as a potential noninvasive alternative.
Answers are grounded in this paper and cite their sources.
Supports rhythm-adjusted NT-proBNP interpretation in acute chest pain, though should not yet change practice; leaves open prospective validation of AF-specific diagnostic cutoffs.
Introduction 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.Methods 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.Results 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).Conclusion 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 and atrial fibrillation (n=824). Plasma and urinary NT-proBNP vs. Sinus rhythm was evaluated on Discrimination of atrial fibrillation from sinus rhythm (AUC 0.85, p=<0.05). Plasma NT-proBNP at a 900 pg/mL cutoff discriminated atrial fibrillation from sinus rhythm with 74% sensitivity and 83% specificity (AUC = 0.85; p < 0.05).
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