Background High plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) indicate increased probability of congestive heart failure (CHF) and atrial fibrillation (AF) and are associated with poor prognosis.
Objective We aimed to describe the clinical and echocardiographic characteristics of a population of individuals aged 75/76 years old with NT-proBNP ≥900 ng/L without previously known CHF or AF.
Methods All individuals aged 75/76 years in the Stockholm region were randomised to a screening study for AF. Half of them were invited to screening. Of those invited, 49.5% agreed to participate. Individuals with NT-proBNP ≥900 ng/L without known CHF were invited for further clinical evaluation.
Results Among 6315 participants without AF who had NT-proBNP sampled, 102 without previously known CHF had ≥900 ng/L. Of these, 93 completed further clinical investigations. In the population that was clinically investigated, 53% were female, and the median NT-proBNP was 1200 ng/L. New AF was found in 28 (30%). The NT-proBNP value in this group was not significantly different from those where AF was not detected (median 1285 vs 1178 ng/L). Patients with newly detected AF had larger left atrial volume and higher pulmonary artery pressure than those without AF. Preserved left ventricular ejection fraction (≥50%) was found in 86% of the participants, mid-range ejection fraction (40%–49%) in 3.2% and reduced ejection fraction (<40%) in 10.8%. Thirteen patients (14%) had other serious cardiac disorders that required medical attention.
Conclusion Elderly individuals with NT-proBNP levels ≥900 ng/L constitute a population at high cardiovascular risk even in the absence of diagnosed CHF or AF, and therefore merit further investigation.
- atrial fibrillation
- heart failure
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Contributors FA-K: conceptualisation, conduct, acquisition, methodology, validation, visualisation, writing, review and editing, and responsible for the overall content. KK-G: conceptualisation, acquisition, methodology, validation, and review and editing. ES, MR: conceptualisation, funding, acquisition, methodology, and review and editing. TF, VF, LF: conceptualisation, acquisition, methodology, and review and editing. JE: conceptualisation, acquisition, methodology, funding, and review and editing.
Funding The study was funded by Roche Diagnostics, Carl Bennet AB, and The Swedish Heart and Lung Foundation. JE and ES were supported by the Stockholm County Council (clinical research appointment).
Competing interests FA-K has received lecture fees from Bayer, Boehringer Ingelheim and BMS/Pfizer. KK-G has received a research grant from Stiftelsen Hjärtat and received lecture fees from BMS/Pfizer. ES has received lecture fees from Bayer, Bristol-Myers Squibb-Pfizer, Boehringer Ingelheim and Sanofi. LF has received consultancy fees from Bayer, Boehringer Ingelheim, BMS/Pfizer and Sanofi. TF has received unrestricted research grants from Boehringer Ingelheim and Stiftelsen Hjärtat. VF has received lecture fees from Merck Sharp & Dohme, Boehringer Ingelheim, Bayer and Medtronic. JE has received consultancy fees from Bristol-Myers Squibb and Pfizer, lecture fees from Merck Sharp & Dohme and Medtronic, and unrestricted research grants from Pfizer. MR received consultancy and lecture fees from Medtronic, Zenicor, Bayer, Boehringer Ingelheim, Pfizer, Bristol-Myers Squibb and Abbott, and research grants from Roche Diagnostics, Bristol-Myers Squibb, Sanofi, Boehringer Ingelheim and Bayer.
Patient consent for publication Not required.
Ethics approval Informed consent was obtained from all patients. The study was approved by the Regional Ethical Review Board (DNR 2015/2079–31/1) and conformed to the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Pseudonymised individual data will be available upon request.
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