Plasmatic NT-proBNP: in ICD-patients without HFrEF strong association with atrial fibrillation

Raphael Allgaier (Hannover)1, C. Strack (Regensburg)2, S. Wallner (Regensburg)3, U. Hubauer (Regensburg)2, P. Lehn (Regensburg)3, A. Luchner (Regensburg)4, L. S. Maier (Regensburg)2, C. G. Jungbauer (Regensburg)2

1Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland; 2Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 3Universitätsklinikum Regensburg Klinische Chemie und Laboratoriumsmedizin Regensburg, Deutschland; 4Krankenhaus Barmherzige Brüder Regensburg Klinik für Kardiologie Regensburg, Deutschland


Background and objectives: Atrial fibrillation is common in patients with chronic heart failure and associated with poor outcome in these patients. Plasmatic NT-proBNP represents the gold standard biomarker for chronic heart failure. Further, a recent analysis showed a strong association of plasmatic NT-proBNP and atrial fibrillation (AFib). Aim of the study was to assess the association of plasmatic NT-proBNP depending on left ventricular ejection fraction (LVEF) in a cohort of patients with implantable cardioverter defibrillator (ICD). 

Methods: Overall 412 patients were included in this study. Blood samples were obtained to assess plasmatic NT-proBNP and follow-up was performed after 45 months. LVEF was estimated by echocardiography according to Simpson’s method. 12-lead electrocardiograms were recorded at enrollment (sinus rhythm (SR, n = 306), atrial fibrillation (AFib, n = 79)). Patients were divided into two subgroups by LVEF of 40% and HFrEF was defined as LVEF ≤ 40%.

Results: Patients suffering from severely reduced LVEF ≤ 40% showed significantly higher age, higher rates of chronic kidney disease, diabetes, coronary artery disease, primary prevention ICD indication, coronary artery disease, dilatative cardiomyopathy and plasmatic NT-proBNP compared to patients with LVEF > 40% (each p < 0.05). There was no difference regarding occurrence of AFib between patients with LVEF ≤ 40% compared to patients with LVEF > 40% (p = n.s.).

In ROC analysis there was a significantly higher AUC in patients with LVEF > 40% (AUC: 0.87, IQR 0.82-0.92) compared to patients with severely reduced LVEF ≤ 40% (AUC: 0.72, IQR 0.64-0.80) regarding plasmatic NT-proBNP and prediction of AFib (p < 0.002).

In patients with LVEF > 40% plasmatic NT-proBNP was shown as significant predictor regarding existence of atrial fibrillation in binary logistic regression analysis, beside age (p < 0.05). Diabetes, hypertension, serum creatinine, coronary artery disease and primary prevention ICD indication were no significant predictors (p = n.s.). In patients with LVEF ≤ 40% plasmatic NT-proBNP was not shown as significant predictor regarding existence of atrial fibrillation in binary logistic regression analysis.

Conclusion: Elevated levels of plasmatic NT-proBNP are not associated with the prevalence of atrial fibrillation in patients with HFrEF. Opposite, in patients with LVEF > 40 % plasmatic NT-proBNP seems to be a relevant predictor for atrial fibrillation in a cohort of ICD patients.

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