Natriuretic peptides for the detection of paroxysmal atrial fibrillation in patients with cerebral ischemia--the Find-AF study |
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Authors: | Wachter Rolf Lahno Rosine Haase Beatrice Weber-Krüger Mark Seegers Joachim Edelmann Frank Wohlfahrt Janin Gelbrich Götz Görlitz Anke Kermer Pawel Vollmann Dirk Hasenfuß Gerd Gröschel Klaus Stahrenberg Raoul |
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Institution: | 1. Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.; 2. Department of Neurology, University of Göttingen, Göttingen, Germany.; 3. Center for Clinical Trials, University of Leipzig, Leipzig, Germany.; 4. Institute for Clinical Trials, University of Göttingen, Göttingen, Germany.; 5. Department of Neurology, University of Mainz, Mainz, Germany.;Inserm, France |
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Abstract: | Background and PurposeDiagnosis of paroxysmal atrial fibrillation (AF) can be challenging, but it is highly relevant in patients presenting with sinus rhythm and acute cerebral ischemia. We aimed to evaluate prospectively whether natriuretic peptide levels and kinetics identify patients with paroxysmal AF.MethodsPatients with acute cerebral ischemia were included into the prospective observational Find-AF study. N-terminal pro brain-type natriuretic peptide (NT-proBNP), brain-type natriuretic peptide (BNP) and N-terminal pro atrial-type natriuretic peptide (NT-proANP) plasma levels were measured on admission, after 6 and 24 hours. Patients free from AF at presentation received 7 day Holter monitoring. We prospectively hypothesized that patients presenting in sinus rhythm with NT-proBNP>median were more likely to have paroxysmal AF than patients with NT-proBNPResults281 patients were included, of whom 237 (84.3%) presented in sinus rhythm. 220 patients naïve to AF with an evaluable prolonged Holter ECG were analysed. In patients with NT-proBNP>median (239 pg/ml), 17.9% had paroxysmal AF in contrast to 7.4% with NT-proBNP<239 pg/ml (p = 0.025). The ratio of early (0 h) to late (24 h) plasma levels of NT-proBNP showed no difference between both groups. For the detection of paroxysmal atrial fibrillation, BNP, NT-proBNP and NT-proANP at admission had an area under the curve in ROC analysis of 0.747 (0.663–0.831), 0.638 (0.531–0.744) and 0.663 (0.566–0.761), respectively. In multivariate analysis, BNP was the only biomarker to be independently predictive for paroxysmal atrial fibrillation.ConclusionsBNP is independently predictive of paroxysmal AF detected by prolonged ECG monitoring in patients with cerebral ischemia and may be used to effectively select patients for prolonged Holter monitoring. |
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