Steady-state B-type natriuretic peptide levels in patients with atrial fibrillation of various clinical backgrounds

Sadanaga, Tsuneaki; Mitamura, Hideo; Kohsaka, Shun; Ogawa, Satoshi

doi:10.1007/s00380-011-0151-3

Cited by 7 publications

(4 citation statements)

References 19 publications

(20 reference statements)

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“…Nonetheless, the prognostic significance of GDF15 in HFpEF was robust even after multivariable adjustment. HFpEF is a syndrome increasingly recognized as an inflammatory condition, and associated with multiple comorbidities, many of which can interfere with the performance characteristics of NT‐proBNP (age, sex, obesity, renal dysfunction and AF) . Our subgroup analysis revealed fairly uniform performance of GDF15 as a prognostic marker in the presence of various comorbidities.…”

Section: Discussionmentioning

confidence: 66%

Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction

Chan

Santhanakrishnan

Chong

et al. 2015

European J of Heart Fail

143

114

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Aim Growth differentiation factor 15 (GDF15) is a cytokine highly expressed in states of inflammatory stress. We aimed to study the clinical correlates and prognostic significance of plasma GDF15 in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction(HFrEF), compared with N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), an indicator of haemodynamic wall stress. Methods Plasma GDF15 and NT‐proBNP were prospectively measured in 916 consecutive patients with HFrEF (EF <50%; n = 730) and HFpEF (EF ≥50%; n = 186), and measured again at 6 months in 488 patients. Patients were followed up for a composite outcome of death or first HF rehospitalization. Results Median GDF15baseline values were similarly elevated in HFpEF [2862 (1812 represent the 25th percentile and 4176 represent the 75th percentile) ng/L] and HFrEF [2517 (1555, 4030) ng/L] (P = 0.184), whereas NT‐proBNP was significantly lower in HFpEF than HFrEF (1119 ng/L vs. 2335 ng/L, P < 0.001). Independent correlates of GDF15baseline were age, systolic blood pressure, New York Heart Association (NYHA) class, diabetes, atrial fibrillation, sodium, haemoglobin, creatinine, diuretic therapy, high sensitivity troponin T (hsTnT) and NT‐proBNP (all P < 0.05). During a median follow‐up of 23 months, there were 379 events (307 HFrEF, 72 HFpEF). GDF15 remained a significant independent predictor for composite outcome even after adjusting for important clinical predictors including hsTnT and NT‐proBNP (adjusted hazard ratio 1.76 per 1 Ln U, 95% confidence interval 1.39–2.21; P < 0.001), regardless of HF group (Pinteraction = 0.275). GDF15baseline provided incremental prognostic value when added to clinical predictors, hsTnT and NT‐proBNP (area under receiver operating characteristic curve increased from 0.720 to 0.740, P < 0.019), with a net reclassification improvement of 0.183 (P = 0.004). Patients with ≥20% GDF156months increase had higher risk for composite outcome (adjusted hazard ratio 1.68, 95% confidence interval 1.15–2.45; P = 0.007) compared with those with GDF156months within ± 20% of baseline. Conclusions The similarly elevated levels and independent prognostic utility of GDF15 in HFrEF and HFpEF suggest that beyond haemodynamic stress (NT‐proBNP), inflammatory injury (GDF15) may play an important role in both HF syndromes.

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Section: Discussionmentioning

confidence: 66%

Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction

Chan

Santhanakrishnan

Chong

et al. 2015

European J of Heart Fail

143

114

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“…We have previously reported that BNP was elevated in a substantial percentage of asymptomatic AF patients, especially chronic AF patients [6]. These AF patients could have latent heart failure and a hypercoagulable state.…”

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confidence: 98%

D-dimer levels positively correlate with B-type natriuretic peptide levels in patients with atrial fibrillation

Sadanaga

Mitamura

Fukuda

et al. 2012

International Journal of Cardiology

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“…Several previous studies demonstrated the elevated blood levels of BNP in patients with AF to compare with subjects with normal sinus rhythm (11,12). Plasma BNP levels in patients with AF were significantly correlated with age, left atrial diameter, left ventricular ejection fraction, diastolic functional parameters including left ventricular hypertrophy, and complication of structural heart disease or heart failure [19,20]. Some of these factors are important components of clinical risk stratification scoring systems for thrombo-embolic events in this disorder [5,6].…”

Section: Discussionmentioning

confidence: 99%

Plasma B-type Natriuretic Peptide as a Predictor of Cardiovascular Events in Subjects with Atrial Fibrillation: A Community-Based Study

et al. 2013

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ObjectivesAtrial fibrillation (AF) is a significant public health issue due to its high prevalence in the general population, and is associated with an increased risk of cardiovascular (CV) events including systemic thrombo-embolism, heart failure, and coronary artery disease. The relationship between plasma B-type natriuretic peptide (BNP) and CV risk in real world AF subjects remains unknown.MethodsThe subject of the study (n = 228; mean age = 69 years) was unselected individuals with AF in a community-based population (n = 15,394; AF prevalence rate = 1.5%). The CV event free rate within each BNP tertile was estimated, and Cox regression analysis was performed to examine the relative risk of the onset of CV events among the tertiles. The prognostic ability of BNP was compared to an established risk score for embolic events (CHADS2 score). In addition, to determine the usefulness of BNP as a predictor in addition to CHADS2 score, we calculated Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices. ResultsDuring the follow-up period 58 subjects experienced CV events (52 per 1,000 person-years). The event-free ratio was significantly lower in the highest tertile (p < 0.02). After adjustment for established CV risk factors, the hazard ratio (HR) of the highest tertile was significantly higher than that of the lowest tertile (HR = 2.38; p < 0.02). The predictive abilities of plasma BNP in terms of sensitivity and specificity for general CV events were comparable to those of CHADS2 score. Adding BNP to the CHADS2 score only model improved the NRI (0.319; p < 0.05) and the IDI (0.046; p < 0.05). ConclusionPlasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general CV risk including stroke, heart failure and acute coronary syndrome in real-world AF subjects.

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Steady-state B-type natriuretic peptide levels in patients with atrial fibrillation of various clinical backgrounds

Cited by 7 publications

References 19 publications

Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction

Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction

D-dimer levels positively correlate with B-type natriuretic peptide levels in patients with atrial fibrillation

Plasma B-type Natriuretic Peptide as a Predictor of Cardiovascular Events in Subjects with Atrial Fibrillation: A Community-Based Study

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