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Arrhythmias and sudden death
Original research
Prediction of incident atrial fibrillation with cardiac biomarkers and left atrial volumes
  1. Magnus Nakrem Lyngbakken1,2,
  2. Peter Selmer Rønningen3,4,
  3. Magnar Gangås Solberg3,4,
  4. Trygve Berge3,
  5. Jon Brynildsen1,
  6. Erika Nerdrum Aagaard1,2,
  7. Brede Kvisvik1,2,
  8. Helge Røsjø2,5,
  9. Kjetil Steine1,4,
  10. Arnljot Tveit3,4,
  11. Torbjørn Omland1,2
  1. 1 Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog, Norway
  2. 2 K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3 Department of Medical Research, Bærum sykehus, Gjettum, Norway
  4. 4 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  5. 5 Division of Research and Innovation, Akershus University Hospital, Lorenskog, Norway
  1. Correspondence to Dr Magnus Nakrem Lyngbakken, Department of Cardiology, Division of Medicine, Akershus University Hospital, Lorenskog 1478, Norway; magnus.lyngbakken{at}medisin.uio.no

Abstract

Objective Atrial fibrillation is a common arrhythmia associated with risk of stroke, heart failure and death. We aimed to elucidate the associations of cardiac biomarkers, echocardiographic left atrial volumetric indices and risk of prevalent and incident atrial fibrillation in the general population.

Methods We assessed cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15), maximum (LAVimax) and minimum (LAVimin) indexed left atrial volumes and left atrial emptying fraction (LAEF) in subjects born in 1950 participating in the prospective observational cohort, Akershus Cardiac Examination 1950 Study. The Cohorts for Heart and Ageing Research in Genomic Epidemiology for Atrial Fibrillation risk score and sex was used to adjust for residual risk of atrial fibrillation.

Results Out of 3487 subjects, 157 (4.5%) had prevalent and 123 (3.5%) had incident atrial fibrillation. Echocardiographic left atrial volumes and cardiac biomarkers associated with prevalent atrial fibrillation, but GDF-15 was non-significant in adjusted analysis. Incident atrial fibrillation was predicted by LAVimax (adjusted HR 1.51, 95% CI 1.30 to 1.75), LAVimin (adjusted HR 1.52, 95% CI 1.35 to 1.72), LAEF (adjusted HR 1.24, 95% CI 1.04 to 1.48) and NT-proBNP (adjusted HR 1.57, 95% CI 1.32 to 1.85). cTnT and NT-proBNP provided incremental prognostic information to left atrial volumes, but GDF-15 demonstrated no prognostic value for incident atrial fibrillation.

Conclusions In the general population, echocardiographic left atrial volumetric indices and NT-proBNP, but not cTnT and GDF-15, associate with prevalent atrial fibrillation and with risk of incident atrial fibrillation. cTnT and NT-proBNP provide incremental prognostic information to echocardiography.

  • atrial fibrillation
  • echocardiography
  • biomarkers

Data availability statement

Data are available on reasonable request. The dataset used in this study is not publicly available, as the Data Protection Authority approval and patient consent do not allow for such publication. However, the study group welcomes initiatives for cooperation, and data access may be granted on application. More information on: www.ace1950.no.

https://doi.org/10.1136/heartjnl-2022-321608

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    Data availability statement

    Data are available on reasonable request. The dataset used in this study is not publicly available, as the Data Protection Authority approval and patient consent do not allow for such publication. However, the study group welcomes initiatives for cooperation, and data access may be granted on application. More information on: www.ace1950.no.

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    Footnotes

    • MNL and PSR are joint first authors.

    • Contributors MNL and PSR contributed equally to this paper. Conception and design: MNL, TB, KS, HR, AT, TO. Acquisition, analysis and interpretation of data: all authors. Drafting of the manuscript: MNL, PSR. Critical revision for important intellectual content: all authors. Final approval of the manuscript: all authors. MNL and PSR were guarantors for the study.

    • Funding The ACE 1950 Study was funded by Vestre Viken Hospital Trust, Akershus University Hospital Trust, South-Eastern Norway Regional Health Authority, University of Oslo and the Norwegian Health Association. Roche Diagnostics provided reagents for GDF-15, cTnT and NT-proBNP analyses free of charge.

    • Disclaimer The funding sources had no role in study concept or design; acquisition, analysis or interpretation of data or preparation of manuscript.

    • Competing interests TO has served on advisory boards for Abbott Diagnostics, Roche Diagnostics and Bayer, and has received research support from Abbott Diagnostics, Novartis, Roche Diagnostics, Singulex and SomaLogic via Akershus University Hospital, and speaker’s or consulting honoraria from Roche Diagnostics, Siemens Healthineers and CardioNor. TB has received speaker fees from Bayer, Boehringer Ingelheim, BMS and Pfizer (non-related to the submitted work). All other authors have no competing interests.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.