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 BoerDirk Jan van Veldhuisen, Michiel Rienstra, Carolyn S. P. Lam, Adriaan A. Voors (Lead / Corresponding author)

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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
Pages (from-to)331-338
Number of pages8
JournalClinical Research in Cardiology
Early online date1 Jul 2019
Publication statusPublished - Mar 2020


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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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