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Arrhythmias and sudden death
Original research article
N-terminal pro B-type natriuretic peptide in systematic screening for atrial fibrillation
  1. Emma Svennberg1,
  2. Peter Henriksson1,
  3. Johan Engdahl1,
  4. Ziad Hijazi2,
  5. Faris Al-Khalili1,
  6. Leif Friberg1,
  7. Viveka Frykman1
  1. 1 Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
  2. 2 Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Emma Svennberg, Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd University Hospital, Hjärtkliniken plan 2, hus 18, Stockholm, SE-182 88, Sweden; emma.svennberg{at}ds.se

Abstract

Objective Screening for atrial fibrillation (AF) in individuals aged 65 and above is recommended by the European Society of Cardiology. Increased levels of the biomarker N-terminal pro B-type natriuretic peptide (NT-proBNP) has in cohort studies been associated with incident AF.

The aim of this study was to assess whether NT-proBNP could be useful for AF detection in systematic screening.

Methods The Strokestop study entailed 7173 Swedish residents aged 75/76 that were screened for AF using twice daily intermittent ECG recordings during 2 weeks. In a substudy of 886 participants, the last 815 consecutive participants and 71 individuals with newly detected AF, levels of NT-proBNP were determined.

Results Participants with newly detected AF (n=96) had a median NT-proBNP of 330 ng/L (IQR 121;634). In individuals without AF (n=742), median NT-proBNP was 171 ng/L (IQR 95;283), p<0.001. The CHA2DS2-VASc parameters did not differ significantly between individuals with newly detected AF and without AF nor between newly detected AF in the NT-proBNP cohort compared with the cohort where NT-proBNP was not assessed. Using an NT-proBNP cut-off of ≥125 ng/L in a non-acute setting yielded a negative predictive value of 92%, meaning that 35% fewer participants would need to be screened when applied to systematic AF screening. Adding weight to NT-proBNP further reduced participants needed to be screened with a preserved sensitivity.

Conclusions NT-proBNP was increased in individuals with newly detected AF. Prospective studies could clarify if NT-proBNP can be used to correctly select individuals that benefit most from AF screening.

Clinical trials ClinicalTrials.gov. Identifier: NCT01593553.

  • Atrial Fibrillation
  • Stroke
  • Epidemiology

https://doi.org/10.1136/heartjnl-2016-310236

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    Footnotes

    • Contributor ES has been responsible for the design, initial draft and revisions of the manuscript, as well as the data collection and part of the analysis. All coauthors have been involved in the design of the study, have been critically reviewing the manuscript, analysed the data (mainly PH) and have been part of this revised manuscript. All authors have given final approval of the submitted version.

    • Funding This work was supported by Stockholm County Council, The Swedish Heart and Lung

      Foundation, King Gustav V and Queen Victoria's Free Masons’ Foundation, the Klebergska

      Foundation, Carl Bennet AB and the Tornspiran Foundation. Roche provided the point-of-

      care analysis apparatus but had no input into the scientific contents of the study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.