NT-proBNP, cardiac troponin predict midterm mortality in symptomatic AF
Patients with symptomatic atrial fibrillation (AF) have increased mortality risk, with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) levels predicting midterm outcome independently, a study reports.
The cohort study included 1,754 consecutive patients (median age 68 years; 44 percent female; median CHA2DS2-VASc score, 3) presenting to a tertiary care university emergency department due to symptomatic AF (n=2,574 episodes). Of these, 1,223 patients contributing 1,780 AF episodes had available data on both NT-proBNP and hs-TnT levels and were included in the final analysis.
Over a median follow-up of 23 months, 162 patients died, with a mortality rate of 4.72 per 100 person-years. Multivariable Cox proportional hazard regression models showed that the risk of death increased with every quintile of NT-proBNP (hazard ratio [HR], 1.53; 95 percent CI, 1.27–1.83; p<0.001) and hs-TnT (HR, 1.31; 1.10–1.55; p=0.002).
There was no interaction observed between NT-proBNP and hs-TnT levels.
The present data suggest that NT-proBNP and hs-TnT can help to decide whether hospitalization and/or specific long-term management are expedient in high-risk AF patients, who are at increased risk of mortality, researchers said.
Researchers pointed out that the use of risk stratification tools is required for a time- and cost-effective treatment of the heterogenous group of patients with AF, and easily accessible biomarkers may aid in this approach.
Cardiac troponins are said to be sensitive biomarkers for the inclusion and exclusion of acute myocardial infarction, as well as to indicate the severity of other noncardiac-related conditions. Given that symptomatic AF is an abnormal physiological state, elevated levels of troponins potentially reflect an oxygen demand/delivery mismatch and changes in microvascular blood flow thus signalling the urgency or emergency of disease. [BMC Pulm Med 2016;16:164; Shock 2017;47:702-708]