Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset

Spyridon Deftereos; Georgios Giannopoulos; Charalampos Kossyvakis; Konstantinos Raisakis; Andreas Kaoukis; Constadina Aggeli; Konstantina Toli; Andreas Theodorakis; Vasiliki Panagopoulou; Metaxia Driva; Ioannis Mantas; Vlasios Pyrgakis; Ilias Rentoukas; Christodoulos Stefanadis

doi:10.1136/hrt.2010.214742

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Heart rhythm disorders

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Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset

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Why NT-proBNP should be less elevated in patients with short onset of atrial fibrillation and/or atrial thrombus?
Christophe Meune
Published on: 23 November 2015

Published on: 23 November 2015
Why NT-proBNP should be less elevated in patients with short onset of atrial fibrillation and/or atrial thrombus?
- Christophe Meune, MD, PhD
- Other Contributors:
  Camille Gobeaux
We read with great interest the study of Deftereos et al (1) about 86 patients with atrial fibrillation (AF). Half of their population had NT- proBNP level (maximum level within 12 hours) below the cut-off value and half had NT-proBNP level above the cut-off value. In addition, they observed higher rates of atrial thrombus (AT) in the group with reduced NT -proBNP concentration. As stated, this is a proof of concept study a...
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We read with great interest the study of Deftereos et al (1) about 86 patients with atrial fibrillation (AF). Half of their population had NT- proBNP level (maximum level within 12 hours) below the cut-off value and half had NT-proBNP level above the cut-off value. In addition, they observed higher rates of atrial thrombus (AT) in the group with reduced NT -proBNP concentration. As stated, this is a proof of concept study and no specific recommendations can be made regarding management of patients with AF. We first assume that these findings should not have direct clinical implications. The authors performed serial measurements of NT-proBNP within 12 hours; based on NT-proBNP concentrations, the probability of left AT ranged from 4.7% to 30.2%. A 4.7% risk is unacceptably high to rule out atrial thombus and recommend any change in disposition of these patients (2). Second, we wonder if there is not a selection bias in their cohort. This is supported by 3 arguments: a) Their population is very young compared to other studies involving AF patients, and more surprisingly, standard deviation is very low (62.2?1.2 years)(2). b) They observed higher rates of AT in the subgroup of patients with lower NT-proBNP concentrations. This finding is somewhat unexpected and is discordant with a previous study from Shimizu et al. (3). Shimizu et al. studied 43 patients and reported that patients with AT and/or thromboembolic events had higher BNP concentrations (3). c) In our population, we studied patients with AF and no heart failure. Time from onset of AF was known, and no patients had AF of only several hours. We observed a correlation (positive, not inversed) between AF duration and NT-proBNP concentration (r=0.532, p=0.0002). Patients with AF of longer duration are assumed to be at high risk of thromboembolic events (2). Third, they used in their study a cut-off value for NT-proBNP that has been established in a distinct population (acute dyspnea in emergency room). In conclusion, the study from Deftereos et al (1) paves the way for urgent clarification. Additional studies should specifically address the question of how to use biomarkers in AF patients. Meanwhile physicians should adhere to recent guidelines (2).
References 1. Deftereos S, Giannopoulos G, Kossyvakis C, et al. Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset. Heart 2011;97:914-7. 2. Guidelines. Camm AJ, Kirchhof P, Lip GYH, et al for The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Guidelines for the management of atrial fibrillation. Eur Heart J 2010 ; 31 :2369-2429. 3. Shimizu H, Murakami Y, Inoue SI, et al. High Plasma Brain Natriuretic Polypeptide Level as a Marker of Risk for Thromboembolism in Patients With Nonvalvular Atrial Fibrillation. Stroke. 2002;33:1005-1010.
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None declared
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Conflict of Interest:
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