title: Natriuretic peptides for the detection of paroxysmal atrial fibrillation in patients with cerebral ischemia--the Find-AF study.
abstract: OBJECTIVE
  Diagnosis of paroxysmal atrial fibrillation (AF) can be challenging, but it is highly relevant in patients presenting with sinus rhythm and acute cerebral ischemia. We aimed to evaluate prospectively whether natriuretic peptide levels and kinetics identify patients with paroxysmal AF.
  
  
  METHODS
  Patients with acute cerebral ischemia were included into the prospective observational Find-AF study. N-terminal pro brain-type natriuretic peptide (NT-proBNP), brain-type natriuretic peptide (BNP) and N-terminal pro atrial-type natriuretic peptide (NT-proANP) plasma levels were measured on admission, after 6 and 24 hours. Patients free from AF at presentation received 7 day Holter monitoring. We prospectively hypothesized that patients presenting in sinus rhythm with NT-proBNP>median were more likely to have paroxysmal AF than patients with NT-proBNP<median.
  
  
  RESULTS
  281 patients were included, of whom 237 (84.3%) presented in sinus rhythm. 220 patients naïve to AF with an evaluable prolonged Holter ECG were analysed. In patients with NT-proBNP>median (239 pg/ml), 17.9% had paroxysmal AF in contrast to 7.4% with NT-proBNP<239 pg/ml (p = 0.025). The ratio of early (0 h) to late (24 h) plasma levels of NT-proBNP showed no difference between both groups. For the detection of paroxysmal atrial fibrillation, BNP, NT-proBNP and NT-proANP at admission had an area under the curve in ROC analysis of 0.747 (0.663-0.831), 0.638 (0.531-0.744) and 0.663 (0.566-0.761), respectively. In multivariate analysis, BNP was the only biomarker to be independently predictive for paroxysmal atrial fibrillation.
  
  
  CONCLUSIONS
  BNP is independently predictive of paroxysmal AF detected by prolonged ECG monitoring in patients with cerebral ischemia and may be used to effectively select patients for prolonged Holter monitoring.
authors.affiliation: Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany. wachter@med.uni-goettingen.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.forename: Rosine
authors.initials: R
authors.lastname: Lahno
authors.forename: Beatrice
authors.initials: B
authors.lastname: Haase
authors.forename: Mark
authors.initials: M
authors.lastname: Weber-Krüger
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.forename: Janin
authors.initials: J
authors.lastname: Wohlfahrt
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Anke
authors.initials: A
authors.lastname: Görlitz
authors.forename: Pawel
authors.initials: P
authors.lastname: Kermer
authors.forename: Dirk
authors.initials: D
authors.lastname: Vollmann
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Klaus
authors.initials: K
authors.lastname: Gröschel
authors.forename: Raoul
authors.initials: R
authors.lastname: Stahrenberg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D002545:Brain Ischemia / Q000150:complications*; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D045265:Natriuretic Peptides / Q000097:blood*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D045265:Natriuretic Peptides