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Original research article
Natriuretic peptides for the detection of paroxysmal atrial fibrillation
  1. Joachim Seegers1,2,
  2. Markus Zabel1,
  3. Timo Grüter1,
  4. Antje Ammermann3,
  5. Mark Weber-Krüger1,
  6. Frank Edelmann1,4,5,6,
  7. Götz Gelbrich7,
  8. Lutz Binder8,
  9. Christoph Herrmann-Lingen4,9,
  10. Klaus Gröschel10,
  11. Gerd Hasenfuß1,4,
  12. Nicolas Feltgen3,
  13. Burkert Pieske5,6 and
  14. Rolf Wachter1,4
  1. 1Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
  2. 2Department of Internal Medicine II—Cardiology, University Hospital Regensburg, Regensburg, Germany
  3. 3Department of Ophthalmology, University of Göttingen, Göttingen, Germany
  4. 4German Cardiovascular Research Center (DZHK), Göttingen, Germany
  5. 5Department of Internal Medicine, Cardiology, Charité – Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany
  6. 6German Cardiovascular Research Center (DZHK), partner site Berlin, Germany
  7. 7Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
  8. 8Department of Clinical Chemistry, University of Göttingen, Göttingen, Germany
  9. 9Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany
  10. 10Department of Neurology, Mainz University Medical Center, Mainz, Germany
  1. Correspondence to Dr Rolf Wachter; Wachter{at}med.uni-goettingen.de

Abstract

Background and purpose Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study.

Methods Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF.

Results 244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3–141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively.

Conclusions NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.

  • BNP brain-type natriuretic peptide

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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