Highlights
- •NT-proBNP showed the best diagnostic performance for detecting non-reduced LVEF HF in patients with symptomatic persistent atrial fibrillation.
- •We might consider higher cut-off points than those presently recommended.
- •Troponin was the best biomarker in distinguish HFmrEF and HFpEF in patients with symptomatic persistent atrial fibrillation.
Abstract
Background
Atrial fibrillation (AF) and heart failure (HF) with non-reduced left ventricle ejection
fraction (LVEF) present a diagnostic overlap. In this paper, we analyze differences
in biomarkers between patients with and without HF, in a cohort of patients presenting
with symptomatic AF. Differences in biomarkers between patients with medium range
ejection fraction HF (HFmrEF) and those with preserved ejection fraction HF (HFpEF)
are also analyzed.
Methods
A total of 115 patients with symptomatic persistent AF were included. Seven biomarkers
were measured: NT-proBNP, high sensitivity T troponin (hsTNT), galectin-3, ST2, fibrinogen,
urate and C-reactive protein.
Results
Patients with non-reduced LVEF HF had significantly higher NT-proBNP levels than those
without HF. This biomarker was the only variable independently related with the presence
of non-reduced LVEF HF. Troponin was the only factor independently related with the
presence of HFmrEF.
Conclusions
NT-proBNP showed the best diagnostic accuracy for detecting the presence of non-reduced
LVEF HF. We found higher diagnostic NT-proBNP cut-off values than those previously
reported. Troponin was the most accurate biomarker differentiating HFmrEF from HFpEF.
Keywords
Abbreviations:
HF (heart failure), LVEF (left ventricular ejection fraction), HFrEF (heart failure with reduced ejection fraction), HFmrEF (heart failure with mid range ejection fraction), HFpEF (heart failure with preserved ejection fraction), AF (atrial fibrillation), hsTnT (high sensitivity troponin T)To read this article in full you will need to make a payment
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References
- 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (ESC)Developed with the special contribution of the heart failure association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
- Prevalence of atrial fibrillation in Spain. OFRECE study results.Rev Esp Cardiol (Engl Ed). 2014; 67: 259-269
- European society of cardiology heart failure long-term registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions.Eur J Heart Fail. 2016; 18: 613-625
- Atrial fibrillation in heart failure with preserved, mid-range, and reduced ejection fraction.JACC Heart Fail. 2017; 5: 565-574
- Edoxaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2013; 369: 2093-2104
- Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-PROBNP): a new marker of cardiac impairment.Clin Endocrinol (Oxf). 1997; 47: 287-296
- Response to letter regarding article, “Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a randomized evaluation of long-term anticoagulation therapy (RE-LY) substudy.Circulation. 2013; 127: e278-e279
- 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur J Cardiothorac Surg. 2016; 50: e1-e88
- Natriuretic peptides in heart failure with preserved left ventricular ejection fraction: from molecular evidences to clinical implications.Int J Mol Sci. 2019; 20
- Heart failure in the elderly.J Geriatr Cardiol. 2016; 13: 115-117
- The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study.Eur J Heart Fail. 2005; 7: 537-541
- The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting.BMJ. 2015; 350: h910
- NT-ProBNP predicts rhythm stability after cardioversion of lone atrial fibrillation.Circ J. 2008; 72: 921-925
- Comprehensive review of the prognostic value of galectin-3 in heart failure.Cardiol Rev. 2014; 22: 171-175
- Clinical relevance of sST2 in cardiac diseases.Clin Chem Lab Med. 2016; 54: 29-35
- ST2 and patient prognosis in chronic heart failure.Am J Cardiol. 2015; 115: 64B-69B
- Troponin elevation in heart failure prevalence, mechanisms, and clinical implications.J Am Coll Cardiol. 2010; 56: 1071-1078
- High-Sensitivity Troponin I and incident coronary events, stroke, heart failure hospitalization, and mortality in the ARIC study.Circulation. 2019; 139: 2642-2653
- Prognostic value of very low plasma concentrations of troponin t in patients with stable chronic heart failure.Circulation. 2007; 116: 1242-1249
- Left ventricular size and ejection fraction: are they still relevant.Heart Fail Clin. 2019; 15: 147-158
- Physical activity, quality of life, and biomarkers in atrial fibrillation and heart failure with preserved ejection fraction (from the NEAT-HFpEF trial).Am J Cardiol. 2019; 123: 1660-1666
- A systems biology study to tailored treatment in chronic heart failure: rationale, design, and baseline characteristics of BIOSTAT-CHF.Eur J Heart Fail. 2016; 18: 716-726
- Comparing biomarker profiles of patients with heart failure: atrial fibrillation vs. sinus rhythm and reduced vs. preserved ejection fraction.Eur Heart J. 2018; 39: 3867-3875
Article info
Publication history
Published online: March 05, 2020
Accepted:
February 21,
2020
Received in revised form:
February 17,
2020
Received:
September 10,
2019
Footnotes
This work was supported by the GRS 1114/A/15 grant to Dr. Perez-Rivera.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
