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Observational Study
. 2020 Mar;109(3):331-338.
doi: 10.1007/s00392-019-01513-y. Epub 2019 Jul 1.

The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

Bernadet T Santema  1 , Michelle M Y Chan  2 , Jasper Tromp  1   2 , Martin Dokter  1 , Haye H van der Wal  1 , Johanna E Emmens  1 , Janny Takens  1 , Nilesh J Samani  3   4 , Leong L Ng  3   4 , Chim C Lang  5 , Peter van der Meer  1 , Jozine M Ter Maaten  1 , Kevin Damman  1 , Kenneth Dickstein  6   7 , John G Cleland  8   9 , Faiez Zannad  10 , Stefan D Anker  11 , Marco Metra  12 , Pim van der Harst  1 , Rudolf A de Boer  1 , Dirk J van Veldhuisen  1 , Michiel Rienstra  1 , Carolyn S P Lam  1   2 , Adriaan A Voors  13
Affiliations
Observational Study

The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

Bernadet T Santema et al. Clin Res Cardiol. 2020 Mar.

Erratum in

Abstract

Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR).

Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738).

Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th-75th percentile 1897-6486] versus 1788 [682-3870], adjusted p < 0.001, versus 2231 pg/mL [902-5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062-5253] versus 2545 [1686-4337], adjusted p = 0.36, versus 2294 [1471-3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort.

Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.

Keywords: Atrial fibrillation; Biomarkers; GDF-15; Heart failure; Natriuretic peptides.

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Conflict of interest statement

SD.A. reports grants from Vifor and Abbott Vascular, and fees for consultancy from Vifor, Bayer, Boehringer Ingelheim, Brahms, Janssen, Novartis, Servier, Stealth Peptides, and ZS Pharma. K.Di. has received honoraria and/or research support from Medtronic, Boston Scientific St Jude, Biotronik and Sorin, and Merck, Novartis, Amgen, Pfizer, Sanofi, Abbott and Servier. C.C.L. received consultancy fees and/or research grants from Amgen, Astra Zeneca, MSD, Novartis, and Servier. D.vV. reports board membership fees/travel expenses from Johnson & Johnson, Novartis, Vifor, and Arca Biopharma. M.M. has received consulting honoraria from Amgen, Astra Zeneca, Novartis, Relypsa, and Servier, and speaker’s fees from Abbott Vascular and Servier. A.A.V. reports consultancy fees and/or research grants from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, GSK, Myokardia, Novartis, Roche Diagnostics and Servier. All other authors declare no conflict of interest.

References

    1. Maisel A, Mueller C, Adams K, Anker SD, Aspromonte N, Cleland JGF, Cohen-Solal A, Dahlstrom U, DeMaria A, Di Somma S, Filippatos GS, Fonarow GC, Jourdain P, Komajda M, Liu PP, McDonagh T, McDonald K, Mebazaa A, Nieminen MS, Peacock WF, Tubaro M, Valle R, Vanderhyden M, Yancy CW, Zannad F, Braunwald E. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008 doi: 10.1016/j.ejheart.2008.07.014. - DOI - PubMed
    1. van Veldhuisen DJ, Linssen GCM, Jaarsma T, van Gilst WH, Hoes AW, Tijssen JGP, Paulus WJ, Voors AA, Hillege HL. B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction. J Am Coll Cardiol. 2013 doi: 10.1016/j.jacc.2012.12.044. - DOI - PubMed
    1. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AHB, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Breathing Not Properly Multinational Study Investigators Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002 doi: 10.1056/NEJMoa020233. - DOI - PubMed
    1. Kotecha D, Lam CS, Van Veldhuisen DJ, Van Gelder IC, Voors AA, Rienstra M. Heart failure with preserved ejection fraction and atrial fibrillation: vicious twins. J Am Coll Cardiol. 2016;68:2217–2228. doi: 10.1016/j.jacc.2016.08.048. - DOI - PubMed
    1. Rienstra M, Van Gelder IC, Van den Berg MP, Boomsma F, Van Veldhuisen DJ. Natriuretic peptides in patients with atrial fibrillation and advanced chronic heart failure: determinants and prognostic value of (NT-)ANP and (NT-pro)BNP. Europace. 2006;8:482–487. doi: 10.1093/europace/eul060. - DOI - PubMed

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