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Biomarkers in atrial fibrillation and heart failure with non-reduced ejection fraction: Diagnostic application and new cut-off points

      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)
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