Natriuretic peptides for the detection of paroxysmal atrial fibrillation.
Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study.



Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF.



244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3-141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively.



NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; Department of Internal Medicine II-Cardiology , University Hospital Regensburg , Regensburg , Germany.
Joachim
J
Seegers
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany.
Markus
M
Zabel
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany.
Timo
T
Grüter
Department of Ophthalmology , University of Göttingen , Göttingen , Germany.
Antje
A
Ammermann
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany.
Mark
M
Weber-Krüger
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany ; Department of Internal Medicine , Cardiology , Charité - Campus Virchow-Klinikum , Universitätsmedizin Berlin , Berlin , Germany ; German Cardiovascular Research Center (DZHK), partner site Berlin, Germany.
Frank
F
Edelmann
Institute for Clinical Epidemiology and Biometry , University of Würzburg , Würzburg , Germany.
Götz
G
Gelbrich
Department of Clinical Chemistry , University of Göttingen , Göttingen , Germany.
Lutz
L
Binder
German Cardiovascular Research Center (DZHK) , Göttingen , Germany ; Department of Psychosomatic Medicine and Psychotherapy , University of Göttingen , Göttingen , Germany.
Christoph
C
Herrmann-Lingen
Department of Neurology , Mainz University Medical Center , Mainz , Germany.
Klaus
K
Gröschel
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany.
Gerd
G
Hasenfuß
Department of Ophthalmology , University of Göttingen , Göttingen , Germany.
Nicolas
N
Feltgen
Department of Internal Medicine , Cardiology , Charité - Campus Virchow-Klinikum , Universitätsmedizin Berlin , Berlin , Germany ; German Cardiovascular Research Center (DZHK), partner site Berlin, Germany.
Burkert
B
Pieske
Department of Cardiology and Pneumology , University of Göttingen , Göttingen , Germany ; German Cardiovascular Research Center (DZHK) , Göttingen , Germany.
Rolf
R
Wachter
BNP brain-type natriuretic peptide