title: Atrial fibrillation and amino-terminal pro-brain natriuretic peptide as independent predictors of prognosis in systolic heart failure.
abstract: BACKGROUND
  Survival of patients with systolic heart failure (HF) may be influenced by the presence of chronic atrial fibrillation (AF) and circulating concentrations of B-type natriuretic peptides. In this study, we sought to assess the prognostic value of chronic AF in comparison to those of amino-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels and of echocardiographic parameters among HF patients of the entire study population and in those with AF.
  
  
  METHODS
  Plasma NT-proBNP levels and echocardiography were prospectively assessed in 489 patients with chronic systolic HF (LV ejection fraction <or=45%) in sinus rhythm or AF (16%). Follow-up duration was 26+/-15 months.
  
  
  RESULTS
  Patients with AF were older (p<0.0001), had a worse NYHA class (p=0.002) and higher NT-proBNP levels (p<0.0001) than those in sinus rhythm. Presence of AF (HR [hazards ratio]: 2.01, p=0.013) and plasma NT-proBNP (HR: 3.05, p<0.0001) were the only independent predictors of all-cause mortality. At receiver operating characteristic analyses, the threshold level for outcome prediction of NT-proBNP was higher in patients with AF (3883 pg/ml) than in patients in sinus rhythm (1653 pg/ml). Multivariate analysis performed in patients with HF and AF showed that plasma NT-proBNP was the most important predictor of death after statistic adjustment for age.
  
  
  CONCLUSIONS
  Chronic AF and NT-proBNP independently predicted the outcome of patients with HF. The threshold level of NT-proBNP for outcome prediction was different in patients with AF with respect to those in sinus rhythm. NT-proBNP was the most important independent predictor of all-cause mortality in HF patients with AF.
authors.affiliation: Unità Operativa Malattie Cardiovascolari 2, Ospedale Santa Chiara, Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gabutti
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: De Tommasi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D015415:Biomarkers; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain