Incremental Value of NT-proBNP Over HCM-AF Score in Risk Stratification for Atrial Fibrillation in Patients With...

HCM-AF score is a novel risk stratification tool for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). N-terminal pro-brain natriuretic peptide (NT-proBNP) has shown promise in predicting AF. We aim to explore the incremental value of NT-proBNP over HCM-AF score.

In this retrospective cohort study, 778 HCM patients were included. The primary endpoint was new-onset AF. Spline curve analysis was conducted to identify the cut-off value of NT-proBNP. Harrell's C-index and likelihood ratio test were conducted to explore the incremental value.

After a follow-up of 3.4 ± 2.3 years, AF occurred in 65 (8.4%) patients. The cut-off of NT-proBNP was 240 pg/mL. Incidence rates of AF per 1000 person-years for the low, intermediate, and high HCM-AF score groups were 8.7 (95% confidence interval [CI]: 3.5-17.7), 18.0 (95% CI: 7.7-48.8), and 59.6 (95% CI: 27.1-157.1), respectively, with the high HCM-AF score group significantly higher. For the low and high NT-proBNP groups, incidence rates were 9.2 (95% CI: 4.6-16.1) and 38.1 (95% CI: 20.3-79.4), respectively. High HCM-AF score (hazard ratio [HR]: 3.55, 95% CI: 1.33-9.48; p = 0.011) and high NT-proBNP (HR: 2.49, 95% CI: 1.21-5.10; p = 0.013) are independent predictors for AF. Addition of NT-proBNP improved models based on HCM-AF score, with C-index increasing from 0.709 to 0.768 and likelihood ratio increasing from 33.15 to 51.02.

HCM-AF score is reliable and robust for Asian HCM patients. NT-proBNP demonstrated incremental value over HCM-AF score in the prediction of new-onset AF in patients with HCM. Future studies are warranted to incorporate HCM-AF score and NT-proBNP.