Atrial ectopy and N-terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study.
Aims
The risk of incident atrial fibrillation (AF) can be estimated by clinical parameters in the Framingham AF risk model. Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) and increased rate of premature atrial contractions (PACs) have been shown to be associated with AF, but the additive value of both of these biomarkers in the Framingham AF risk model has not been fully examined.


Methods and results
A total of 646 subjects from the Copenhagen Holter Study (mean age 64.4 ± 6.8 years, 41.6% women) with no history of prior AF, stroke or cardiovascular disease were followed for the diagnosis of incident AF or death (median follow-up time 14.4 years). Median NT-proBNP was 6.7 pmol/L (IQR: 3.6-13.5), median PAC count was 1.4 beats/h (IQR: 0.6-4.5), 71 (11.0%) subjects developed AF, and 244 (37.8%) died. Multiple Cox regression including Framingham AF risk score, log-transformed NT-proBNP, and log-transformed PAC showed a significant increase in AF hazard risk [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.14-1.85, P = 0.002; HR 1.23, 95% CI 1.09-1.39, P = 0.001]. The addition of PAC to the Framingham AF risk model significantly improved the time-dependent area under the receiver operating characteristic curve (AUC 65.6 vs. 72.6; P = 0.008), while the addition of NT-proBNP did not.


Conclusion
Atrial fibrillation risk discrimination was significantly improved by the addition of PAC to the Framingham AF risk model, but not by the addition of NT-proBNP.
['Kumarathurai|Preman|P|', 'Mouridsen|Mette R|MR|', 'Mattsson|Nick|N|', 'Larsen|Bjørn S|BS|', 'Nielsen|Olav W|OW|', 'Gerds|Thomas A|TA|', 'Sajadieh|Ahmad|A|']
D000368:Aged D019540:Area Under Curve D001281:Atrial Fibrillation D018880:Atrial Premature Complexes D015415:Biomarkers D003718:Denmark D015716:Electrocardiography, Ambulatory D005260:Female D006329:Heart Conduction System D006339:Heart Rate D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D020097:Natriuretic Peptide, Brain D010446:Peptide Fragments D011237:Predictive Value of Tests D011379:Prognosis D016016:Proportional Hazards Models D012372:ROC Curve D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
Natriuretic peptides Atrial fibrillation Premature atrial contractions Arrhythmia Epidemiology Prediction models Prognosis Risk factors