BACKGROUND: Biomarkers of multiple pathophysiological pathways have been related to incident atrial fibrillation (AF), but their predictive ability remains controversial. METHODS AND RESULTS: In 3120 Framingham cohort participants (mean age 58.4+/-9.7 years, 54% women), we related 10 biomarkers that represented inflammation (C-reactive protein and fibrinogen), neurohormonal activation (B-type natriuretic peptide [BNP] and N-terminal proatrial natriuretic peptide), oxidative stress (homocysteine), the renin-angiotensin-aldosterone system (renin and aldosterone), thrombosis and endothelial function (D-dimer and plasminogen activator inhibitor type 1), and microvascular damage (urinary albumin excretion; n=2673) to incident AF (n=209, 40% women) over a median follow-up of 9.7 years (range 0.05 to 12.8 years). In multivariable-adjusted analyses, the biomarker panel was associated with incident AF (P<0.0001). In stepwise-selection models (P<0.01 for entry and retention), log-transformed BNP (hazard ratio per SD 1.62, 95% confidence interval 1.41 to 1.85, P<0.0001) and C-reactive protein (hazard ratio 1.25, 95% confidence interval 1.07 to 1.45, P=0.004) were chosen. The addition of BNP to variables recently combined in a risk score for AF increased the C-statistic from 0.78 (95% confidence interval 0.75 to 0.81) to 0.80 (95% confidence interval 0.78 to 0.83) and showed an integrated discrimination improvement of 0.03 (95% confidence interval 0.02 to 0.04, P<0.0001), with 34.9% relative improvement in reclassification analysis. The combined analysis of BNP and C-reactive protein did not appreciably improve risk prediction over the model that incorporated BNP in addition to the risk factors. CONCLUSIONS: BNP is a predictor of incident AF and improves risk stratification based on well-established clinical risk factors. Whether knowledge of BNP concentrations may be used to target individuals at risk of AF for more intensive monitoring or primary prevention requires further investigation.
BACKGROUND: Biomarkers of multiple pathophysiological pathways have been related to incident atrial fibrillation (AF), but their predictive ability remains controversial. METHODS AND RESULTS: In 3120 Framingham cohort participants (mean age 58.4+/-9.7 years, 54% women), we related 10 biomarkers that represented inflammation (C-reactive protein and fibrinogen), neurohormonal activation (B-type natriuretic peptide [BNP] and N-terminal proatrial natriuretic peptide), oxidative stress (homocysteine), the renin-angiotensin-aldosterone system (renin and aldosterone), thrombosis and endothelial function (D-dimer and plasminogen activator inhibitor type 1), and microvascular damage (urinary albumin excretion; n=2673) to incident AF (n=209, 40% women) over a median follow-up of 9.7 years (range 0.05 to 12.8 years). In multivariable-adjusted analyses, the biomarker panel was associated with incident AF (P<0.0001). In stepwise-selection models (P<0.01 for entry and retention), log-transformed BNP (hazard ratio per SD 1.62, 95% confidence interval 1.41 to 1.85, P<0.0001) and C-reactive protein (hazard ratio 1.25, 95% confidence interval 1.07 to 1.45, P=0.004) were chosen. The addition of BNP to variables recently combined in a risk score for AF increased the C-statistic from 0.78 (95% confidence interval 0.75 to 0.81) to 0.80 (95% confidence interval 0.78 to 0.83) and showed an integrated discrimination improvement of 0.03 (95% confidence interval 0.02 to 0.04, P<0.0001), with 34.9% relative improvement in reclassification analysis. The combined analysis of BNP and C-reactive protein did not appreciably improve risk prediction over the model that incorporated BNP in addition to the risk factors. CONCLUSIONS:BNP is a predictor of incident AF and improves risk stratification based on well-established clinical risk factors. Whether knowledge of BNP concentrations may be used to target individuals at risk of AF for more intensive monitoring or primary prevention requires further investigation.
Authors: Ulrik Dixen; Lasse Ravn; Christian Soeby-Rasmussen; Anders Wallin Paulsen; Jan Parner; Erik Frandsen; Gorm B Jensen Journal: Cardiology Date: 2006-09-12 Impact factor: 1.869
Authors: Cathrine W Knudsen; Paul Clopton; Arne Westheim; Tor Ole Klemsdal; Alan H B Wu; Philippe Duc; James McCord; Richard M Nowak; Judd E Hollander; Alan B Storrow; William T Abraham; Peter A McCullough; Alan S Maisel; Torbjørn Omland Journal: Ann Emerg Med Date: 2005-06 Impact factor: 5.721
Authors: Renate Schnabel; Martin G Larson; Josée Dupuis; Kathryn L Lunetta; Izabella Lipinska; James B Meigs; Xiaoyan Yin; Jian Rong; Joseph A Vita; Christopher Newton-Cheh; Daniel Levy; John F Keaney; Ramachandran S Vasan; Gary F Mitchell; Emelia J Benjamin Journal: Hypertension Date: 2008-04-21 Impact factor: 10.190
Authors: David Conen; Paul M Ridker; Brendan M Everett; Usha B Tedrow; Lynda Rose; Nancy R Cook; Julie E Buring; Christine M Albert Journal: Eur Heart J Date: 2010-05-25 Impact factor: 29.983
Authors: Claire Sweeney; Fiona Ryan; Mark Ledwidge; Cristin Ryan; Ken McDonald; Chris Watson; Rebabonye B Pharithi; Joe Gallagher Journal: Cochrane Database Syst Rev Date: 2019-10-15
Authors: Karl Georg Haeusler; Klaus Gröschel; Martin Köhrmann; Stefan D Anker; Johannes Brachmann; Michael Böhm; Hans-Christoph Diener; Wolfram Doehner; Matthias Endres; Christian Gerloff; Hagen B Huttner; Manfred Kaps; Paulus Kirchhof; Darius Günther Nabavi; Christian H Nolte; Waltraud Pfeilschifter; Burkert Pieske; Sven Poli; Wolf Rüdiger Schäbitz; Götz Thomalla; Roland Veltkamp; Thorsten Steiner; Ulrich Laufs; Joachim Röther; Rolf Wachter; Renate Schnabel Journal: Clin Res Cardiol Date: 2018-04-27 Impact factor: 5.460
Authors: A Mantovani; R Rigolon; I Pichiri; M Pernigo; C Bergamini; G Zoppini; E Bonora; G Targher Journal: J Endocrinol Invest Date: 2015-07-16 Impact factor: 4.256
Authors: Mary Cushman; Suzanne E Judd; Virginia J Howard; Brett Kissela; Orlando M Gutiérrez; Nancy S Jenny; Ali Ahmed; Evan L Thacker; Neil A Zakai Journal: Stroke Date: 2014-04-22 Impact factor: 7.914
Authors: Joshua D Bundy; Susan R Heckbert; Lin Y Chen; Donald M Lloyd-Jones; Philip Greenland Journal: Am J Cardiol Date: 2019-10-10 Impact factor: 2.778
Authors: Martin Greif; Franz von Ziegler; Reza Wakili; Janine Tittus; Christoph Becker; Susanne Helbig; Ruediger P Laubender; Wolfgang Schwarz; Melvin D'Anastasi; Jan Schenzle; Alexander W Leber; Alexander Becker Journal: Clin Res Cardiol Date: 2013-04-13 Impact factor: 5.460