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

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 - 2020/3

Y1 - 2020/3

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

UR - https://www.scopus.com/pages/publications/85069435767

U2 - 10.1007/s00392-019-01513-y

DO - 10.1007/s00392-019-01513-y

M3 - Article

C2 - 31263996

SN - 1861-0684

VL - 109

SP - 331

EP - 338

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

ER -