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Plasma B-type natriuretic peptide as a predictor of cardiovascular events in subjects with atrial fibrillation: a
Motoyuki Nakamura1, Yorihiko Koeda, Fumitaka Tanaka
1Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Insights
Plasma B-type natriuretic peptide (BNP) effectively predicts cardiovascular events in atrial fibrillation (AF) patients. Adding BNP to the CHADS2 score improves risk prediction for stroke, heart failure, and acute coronary syndrome.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Atrial fibrillation (AF) is a prevalent condition linked to increased cardiovascular (CV) risk.
- The prognostic value of plasma B-type natriuretic peptide (BNP) in real-world AF populations is not well-established.
Purpose of the Study:
- To investigate the relationship between plasma BNP levels and CV risk in individuals with AF.
- To compare the predictive ability of BNP with the CHADS2 score and assess its added value.
Main Methods:
- A community-based study of 228 individuals with AF was conducted.
- Cox regression analysis and risk reclassification indices (NRI, IDI) were used to evaluate BNP's prognostic performance.
Main Results:
- Higher plasma BNP tertiles were associated with a significantly lower CV event-free rate.
- Plasma BNP demonstrated predictive abilities comparable to the CHADS2 score.
- Incorporating BNP into the CHADS2 score significantly improved CV risk prediction.
Conclusions:
- Plasma BNP is a valuable biomarker for assessing general CV risk in AF patients.
- BNP can be used alone or combined with existing scoring systems for enhanced risk stratification.
Objectives:
Atrial 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.
Methods:
The 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.
Results:
During 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).
Conclusion:
Plasma 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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