Jun Xiao1,2, Anders P Persson3, Gunnar Engström3, Linda S B Johnson4. 1. Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China. jun.xiao@med.lu.se. 2. Department of Clinical Sciences in Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. jun.xiao@med.lu.se. 3. Department of Clinical Sciences in Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. 4. Department of Clinical Sciences in Malmö, Lund University, CRC 60:13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. Linda.Johnson@med.lu.se.
Abstract
BACKGROUND: Frequent supraventricular arrhythmia is associated with increased incidence of atrial fibrillation. However, it is unknown whether the prognostic significance of supraventricular arrhythmia is modified by plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) or troponin T (TnT). This study examined the interrelationships between NT-proBNP, TnT levels and frequent supraventricular arrhythmia, and whether these biomarkers and a measure of frequent supraventricular arrhythmia could improve risk assessment for incidence of AF. METHODS: Supraventricular extrasystoles (SVEs) and supraventricular tachycardias were assessed from 24-h electrocardiograph recordings in 373 individuals initially without AF. Elevated NT-pro-BNP, TnT and SVEs was defined as a measurement in the top quartile of the study population distribution. Incident cases of AF were retrieved by linkage with the Swedish National Patient Register. RESULTS: During a mean follow-up of 15.4 years, 88 subjects had a diagnosis of AF. After multivariable adjustment, individuals with both elevated NT-proBNP and frequent SVEs had a significantly increased incidence of AF, compared to subjects without elevated NT-proBNP or frequent SVEs (hazard ratio (HR) 4.61, 95% confidence interval (CI) 2.45-8.69), and compared to individuals with either elevated NT-proBNP or frequent SVEs (both P < 0.05). HRs for frequent SVEs alone or elevated NT-proBNP alone were 2.32 (95% CI 1.33-4.06) and 1.52 (95% CI 0.76-3.05), respectively. The addition of NT-pro-BNP and SVEs to a validated risk prediction score for AF, CHARGE-AF, resulted in improved prediction (Harrell's C 0.751 (95% CI 0.702-0.799) vs 0.720 (95% CI 0.669-0.771), P = 0.015). CONCLUSION: Subjects with both elevated NT-proBNP and frequent SVEs have substantially increased risk of AF, and the use of these variables could improve long-term prediction of incident AF.
BACKGROUND: Frequent supraventricular arrhythmia is associated with increased incidence of atrial fibrillation. However, it is unknown whether the prognostic significance of supraventricular arrhythmia is modified by plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) or troponin T (TnT). This study examined the interrelationships between NT-proBNP, TnT levels and frequent supraventricular arrhythmia, and whether these biomarkers and a measure of frequent supraventricular arrhythmia could improve risk assessment for incidence of AF. METHODS: Supraventricular extrasystoles (SVEs) and supraventricular tachycardias were assessed from 24-h electrocardiograph recordings in 373 individuals initially without AF. Elevated NT-pro-BNP, TnT and SVEs was defined as a measurement in the top quartile of the study population distribution. Incident cases of AF were retrieved by linkage with the Swedish National Patient Register. RESULTS: During a mean follow-up of 15.4 years, 88 subjects had a diagnosis of AF. After multivariable adjustment, individuals with both elevated NT-proBNP and frequent SVEs had a significantly increased incidence of AF, compared to subjects without elevated NT-proBNP or frequent SVEs (hazard ratio (HR) 4.61, 95% confidence interval (CI) 2.45-8.69), and compared to individuals with either elevated NT-proBNP or frequent SVEs (both P < 0.05). HRs for frequent SVEs alone or elevated NT-proBNP alone were 2.32 (95% CI 1.33-4.06) and 1.52 (95% CI 0.76-3.05), respectively. The addition of NT-pro-BNP and SVEs to a validated risk prediction score for AF, CHARGE-AF, resulted in improved prediction (Harrell's C 0.751 (95% CI 0.702-0.799) vs 0.720 (95% CI 0.669-0.771), P = 0.015). CONCLUSION: Subjects with both elevated NT-proBNP and frequent SVEs have substantially increased risk of AF, and the use of these variables could improve long-term prediction of incident AF.
Authors: J Gustav Smith; Christopher Newton-Cheh; Peter Almgren; Joachim Struck; Nils G Morgenthaler; Andreas Bergmann; Pyotr G Platonov; Bo Hedblad; Gunnar Engström; Thomas J Wang; Olle Melander Journal: J Am Coll Cardiol Date: 2010-11-16 Impact factor: 24.094
Authors: Kai M Eggers; Jinan Al-Shakarchi; Lars Berglund; Bertil Lindahl; Agneta Siegbahn; Lars Wallentin; Björn Zethelius Journal: Am Heart J Date: 2013-08-13 Impact factor: 4.749
Authors: Thomas A Dewland; Eric Vittinghoff; Mala C Mandyam; Susan R Heckbert; David S Siscovick; Phyllis K Stein; Bruce M Psaty; Nona Sotoodehnia; John S Gottdiener; Gregory M Marcus Journal: Ann Intern Med Date: 2013-12-03 Impact factor: 25.391
Authors: Kristen K Patton; Patrick T Ellinor; Susan R Heckbert; Robert H Christenson; Christopher DeFilippi; John S Gottdiener; Richard A Kronmal Journal: Circulation Date: 2009-10-19 Impact factor: 29.690