title: Predictive value of NT-proBNP for cardioversion in a new onset atrial fibrillation.
abstract: OBJECTIVE
  To detect the clinical use of N-terminal pro B-type natriuretic peptide (NT-proBNP) values for predicting cardioversion in a new onset atrial fibrillation (AF) in the emergency department.
  
  
  METHODS
  NT-proBNP was measured in 200 patients admitted to the emergency department, in the observational unit with primary diagnosis of a new onset AF (<2 weeks). Cohort was divided into rate-control and rhythm-control groups according to the strategy used by the admitting physician. Patients treated with electric cardioversion were excluded. Primary endpoint was conversion to sinus rhythm during hospital admission.
  
  
  RESULTS
  In rhythm and rate controls, NT-proBNP was lower in patients who restored sinus rhythm (P<0.001). Same result was observed even when logistic regression was used to adjust for differences at baseline clinical characteristics. NT-proBNP of less than 450 pg/ml was associated with cardioversion in both the groups (likelihood ratio of 0.19 for rate control, and 0.27 for rhythm control) whereas a value of more than 1800 pg/ml was associated with persistent AF at discharge (likelihood ratio of 2.02 and 2.01, respectively).
  
  
  CONCLUSIONS
  In the acute setting of a new onset AF, NT-proBNP seems to predict cardioversion in rate-control and rhythm-control strategies when it is less than 450 pg/ml or more than 1800 pg/ml. In this ranges of values it might help to allocate resources and plan for patient admission and further management. There is a grey area (450-1800 pg/ml) in which NT-proBNP did not seem to be clinically useful.
authors.affiliation: Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy. f_buccelletti@yahoo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccelletti
authors.forename: Emanuele
authors.initials: E
authors.lastname: Gilardi
authors.forename: Davide
authors.initials: D
authors.lastname: Marsiliani
authors.forename: Annarita
authors.initials: A
authors.lastname: Carroccia
authors.forename: Nicolò Gentiloni
authors.initials: NG
authors.lastname: Silveri
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D015415:Biomarkers; D015331:Cohort Studies; D004554:Electric Countershock / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain