The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

Bernadet T. Santema, Michelle M. Y. Chan, Jasper Tromp, Martin Dokter, Haye van der Wal, Johanna E. Emmens, Janny Takens, Nilesh J. Samani, Leong Loke Ng, Chim Lang, Peter van der Meer, Jozine M. ter Maaten, Kevin Damman, Kenneth Dickstein, John G. Cleland, Faiez Zannad, Stefan D. Anker, Marco Metra, Pim van der Harst, Rudolf A. de Boer & 4 others Dirk Jan van Veldhuisen, Michiel Rienstra, Carolyn S. P. Lam, Adriaan A. Voors

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Abstract

Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.

Original languageEnglish
Number of pages8
JournalClinical Research in Cardiology
Early online date1 Jul 2019
DOIs
Publication statusE-pub ahead of print - 1 Jul 2019

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Growth Differentiation Factor 15
Atrial Fibrillation
Heart Failure
pro-brain natriuretic peptide (1-76)

Keywords

  • Atrial fibrillation
  • Biomarkers
  • GDF-15
  • Heart failure
  • Natriuretic peptides

Cite this

Santema, Bernadet T. ; Chan, Michelle M. Y. ; Tromp, Jasper ; Dokter, Martin ; van der Wal, Haye ; Emmens, Johanna E. ; Takens, Janny ; Samani, Nilesh J. ; Ng, Leong Loke ; Lang, Chim ; van der Meer, Peter ; ter Maaten, Jozine M. ; Damman, Kevin ; Dickstein, Kenneth ; Cleland, John G. ; Zannad, Faiez ; Anker, Stefan D. ; Metra, Marco ; van der Harst, Pim ; de Boer, Rudolf A. ; van Veldhuisen, Dirk Jan ; Rienstra, Michiel ; Lam, Carolyn S. P. ; Voors, Adriaan A. / The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure. In: Clinical Research in Cardiology . 2019.
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title = "The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure",
abstract = "Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.",
keywords = "Atrial fibrillation, Biomarkers, GDF-15, Heart failure, Natriuretic peptides",
author = "Santema, {Bernadet T.} and Chan, {Michelle M. Y.} and Jasper Tromp and Martin Dokter and {van der Wal}, Haye and Emmens, {Johanna E.} and Janny Takens and Samani, {Nilesh J.} and Ng, {Leong Loke} and Chim Lang and {van der Meer}, Peter and {ter Maaten}, {Jozine M.} and Kevin Damman and Kenneth Dickstein and Cleland, {John G.} and Faiez Zannad and Anker, {Stefan D.} and Marco Metra and {van der Harst}, Pim and {de Boer}, {Rudolf A.} and {van Veldhuisen}, {Dirk Jan} and Michiel Rienstra and Lam, {Carolyn S. P.} and Voors, {Adriaan A.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1007/s00392-019-01513-y",
language = "English",
journal = "Clinical Research in Cardiology",
issn = "1861-0684",
publisher = "Springer Verlag",

}

Santema, BT, Chan, MMY, Tromp, J, Dokter, M, van der Wal, H, Emmens, JE, Takens, J, Samani, NJ, Ng, LL, Lang, C, van der Meer, P, ter Maaten, JM, Damman, K, Dickstein, K, Cleland, JG, Zannad, F, Anker, SD, Metra, M, van der Harst, P, de Boer, RA, van Veldhuisen, DJ, Rienstra, M, Lam, CSP & Voors, AA 2019, 'The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure', Clinical Research in Cardiology . https://doi.org/10.1007/s00392-019-01513-y

The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure. / Santema, Bernadet T.; Chan, Michelle M. Y.; Tromp, Jasper ; Dokter, Martin; van der Wal, Haye ; Emmens, Johanna E.; Takens, Janny; Samani, Nilesh J.; Ng, Leong Loke; Lang, Chim; van der Meer, Peter; ter Maaten, Jozine M.; Damman, Kevin; Dickstein, Kenneth; Cleland, John G.; Zannad, Faiez; Anker, Stefan D.; Metra, Marco; van der Harst, Pim; de Boer, Rudolf A.; van Veldhuisen, Dirk Jan; Rienstra, Michiel; Lam, Carolyn S. P.; Voors, Adriaan A. (Lead / Corresponding author).

In: Clinical Research in Cardiology , 01.07.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

AU - Santema, Bernadet T.

AU - Chan, Michelle M. Y.

AU - Tromp, Jasper

AU - Dokter, Martin

AU - van der Wal, Haye

AU - Emmens, Johanna E.

AU - Takens, Janny

AU - Samani, Nilesh J.

AU - Ng, Leong Loke

AU - Lang, Chim

AU - van der Meer, Peter

AU - ter Maaten, Jozine M.

AU - Damman, Kevin

AU - Dickstein, Kenneth

AU - Cleland, John G.

AU - Zannad, Faiez

AU - Anker, Stefan D.

AU - Metra, Marco

AU - van der Harst, Pim

AU - de Boer, Rudolf A.

AU - van Veldhuisen, Dirk Jan

AU - Rienstra, Michiel

AU - Lam, Carolyn S. P.

AU - Voors, Adriaan A.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.

AB - Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.

KW - Atrial fibrillation

KW - Biomarkers

KW - GDF-15

KW - Heart failure

KW - Natriuretic peptides

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U2 - 10.1007/s00392-019-01513-y

DO - 10.1007/s00392-019-01513-y

M3 - Article

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

ER -