Natriuretic peptides for the detection of paroxysmal atrial fibrillation.

Autor:	Seegers J; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; Department of Internal Medicine II-Cardiology , University Hospital Regensburg , Regensburg , Germany., Zabel M; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany., Grüter T; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany., Ammermann A; Department of Ophthalmology , University of Göttingen , Göttingen , Germany., Weber-Krüger M; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany., Edelmann F; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany ; Department of Internal Medicine , Cardiology , Charité - Campus Virchow-Klinikum , Universitätsmedizin Berlin , Berlin , Germany ; German Cardiovascular Research Center (DZHK), partner site Berlin, Germany., Gelbrich G; Institute for Clinical Epidemiology and Biometry , University of Würzburg , Würzburg , Germany., Binder L; Department of Clinical Chemistry , University of Göttingen , Göttingen , Germany., Herrmann-Lingen C; German Cardiovascular Research Center (DZHK) , Göttingen , Germany ; Department of Psychosomatic Medicine and Psychotherapy , University of Göttingen , Göttingen , Germany., Gröschel K; Department of Neurology , Mainz University Medical Center , Mainz , Germany., Hasenfuß G; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany., Feltgen N; Department of Ophthalmology , University of Göttingen , Göttingen , Germany., Pieske B; Department of Internal Medicine , Cardiology , Charité - Campus Virchow-Klinikum , Universitätsmedizin Berlin , Berlin , Germany ; German Cardiovascular Research Center (DZHK), partner site Berlin, Germany., Wachter R; Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany.
Jazyk:	angličtina
Zdroj:	Open heart [Open Heart] 2015 Aug 03; Vol. 2 (1), pp. e000182. Date of Electronic Publication: 2015 Aug 03 (Print Publication: 2015).
DOI:	10.1136/openhrt-2014-000182
Abstrakt:	Background and Purpose: Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study. Methods: Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF. Results: 244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3-141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively. Conclusions: NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.
Databáze:	MEDLINE
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