Natriuretic Peptides for the Detection of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemia – the Find-AF StudyReportar como inadecuado




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Background and Purpose

Diagnosis of paroxysmal atrial fibrillation AF can be challenging, but it is highly relevant in patients presenting with sinus rhythm and acute cerebral ischemia. We aimed to evaluate prospectively whether natriuretic peptide levels and kinetics identify patients with paroxysmal AF.

Methods

Patients with acute cerebral ischemia were included into the prospective observational Find-AF study. N-terminal pro brain-type natriuretic peptide NT-proBNP, brain-type natriuretic peptide BNP and N-terminal pro atrial-type natriuretic peptide NT-proANP plasma levels were measured on admission, after 6 and 24 hours. Patients free from AF at presentation received 7 day Holter monitoring. We prospectively hypothesized that patients presenting in sinus rhythm with NT-proBNP>median were more likely to have paroxysmal AF than patients with NT-proBNP
Results

281 patients were included, of whom 237 84.3% presented in sinus rhythm. 220 patients naïve to AF with an evaluable prolonged Holter ECG were analysed. In patients with NT-proBNP>median 239 pg-ml, 17.9% had paroxysmal AF in contrast to 7.4% with NT-proBNP<239 pg-ml p = 0.025. The ratio of early 0 h to late 24 h plasma levels of NT-proBNP showed no difference between both groups. For the detection of paroxysmal atrial fibrillation, BNP, NT-proBNP and NT-proANP at admission had an area under the curve in ROC analysis of 0.747 0.663–0.831, 0.638 0.531–0.744 and 0.663 0.566–0.761, respectively. In multivariate analysis, BNP was the only biomarker to be independently predictive for paroxysmal atrial fibrillation.

Conclusions

BNP is independently predictive of paroxysmal AF detected by prolonged ECG monitoring in patients with cerebral ischemia and may be used to effectively select patients for prolonged Holter monitoring.



Autor: Rolf Wachter , Rosine Lahno, Beatrice Haase, Mark Weber-Krüger, Joachim Seegers, Frank Edelmann, Janin Wohlfahrt, Götz Gelbrich

Fuente: http://plos.srce.hr/



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