B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation

Taku Inohara, Sunghee Kim, Karen Pieper, Rosalia G. Blanco, Larry A. Allen, Gregg C. Fonarow, Bernard J. Gersh, Michael D. Ezekowitz, Peter R. Kowey, James A. Reiffel, Gerald V. Naccarelli, Paul S. Chan, Kenneth W. Mahaffey, Daniel E. Singer, James V. Freeman, Benjamin A. Steinberg, Eric D. Peterson, Jonathan P. Piccini

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective The association with B-type natriuretic peptide (BNP), disease progression and outcomes in patients with atrial fibrillation (AF) has not been thoroughly investigated. Methods We evaluated the association between BNP levels and outcomes, including AF progression, composite outcome of major adverse cardiovascular or neurological events (MACNE) and major bleeding, via pooled logistic regression and Cox frailty models in Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry. AF progression was defined as either paroxysmal becoming persistent or permanent, or persistent becoming permanent at any follow-up. Results Among 13 375 patients with AF, 2797 with BNP values at baseline (median age (IQR), 72.0 (63.0-80.0) years; 43.0% women; median BNP, 238 (102-502) ng/L; 42.3% prior heart failure) were included in the models evaluating the association between BNP levels and MACNE or major bleeding. Of these, 1282 patients with paroxysmal or persistent AF at baseline were analysed in AF progression model. The likelihood of AF progression (adjusted OR, 1.11 for every 100 ng/mL; 95% CI 1.03 to 1.19) and MACNE (adjusted HR, 1.11 for every doubling in BNP values; 95% CI 1.01 to 1.22) increased with BNP concentration, while the elevated BNP values were not associated with increased risks of major bleeding. BNP values improved the risk prediction of AF progression and MACNE when added to conventional risk estimates. Conclusions BNP levels are associated with increased risk of AF progression and cardiovascular outcomes in patients with AF. Further studies are required to assess whether biomarker-based risk stratification improves patient outcomes. Clinical trial registration NCT01701817.

Original languageEnglish (US)
Pages (from-to)370-377
Number of pages8
JournalHeart
Volume105
Issue number5
DOIs
StatePublished - Mar 1 2019

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Brain Natriuretic Peptide
Atrial Fibrillation
Disease Progression
Hemorrhage
Registries
Proportional Hazards Models
Heart Failure
Biomarkers
Logistic Models
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Inohara, T., Kim, S., Pieper, K., Blanco, R. G., Allen, L. A., Fonarow, G. C., ... Piccini, J. P. (2019). B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation. Heart, 105(5), 370-377. https://doi.org/10.1136/heartjnl-2018-313642
Inohara, Taku ; Kim, Sunghee ; Pieper, Karen ; Blanco, Rosalia G. ; Allen, Larry A. ; Fonarow, Gregg C. ; Gersh, Bernard J. ; Ezekowitz, Michael D. ; Kowey, Peter R. ; Reiffel, James A. ; Naccarelli, Gerald V. ; Chan, Paul S. ; Mahaffey, Kenneth W. ; Singer, Daniel E. ; Freeman, James V. ; Steinberg, Benjamin A. ; Peterson, Eric D. ; Piccini, Jonathan P. / B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation. In: Heart. 2019 ; Vol. 105, No. 5. pp. 370-377.
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abstract = "Objective The association with B-type natriuretic peptide (BNP), disease progression and outcomes in patients with atrial fibrillation (AF) has not been thoroughly investigated. Methods We evaluated the association between BNP levels and outcomes, including AF progression, composite outcome of major adverse cardiovascular or neurological events (MACNE) and major bleeding, via pooled logistic regression and Cox frailty models in Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry. AF progression was defined as either paroxysmal becoming persistent or permanent, or persistent becoming permanent at any follow-up. Results Among 13 375 patients with AF, 2797 with BNP values at baseline (median age (IQR), 72.0 (63.0-80.0) years; 43.0{\%} women; median BNP, 238 (102-502) ng/L; 42.3{\%} prior heart failure) were included in the models evaluating the association between BNP levels and MACNE or major bleeding. Of these, 1282 patients with paroxysmal or persistent AF at baseline were analysed in AF progression model. The likelihood of AF progression (adjusted OR, 1.11 for every 100 ng/mL; 95{\%} CI 1.03 to 1.19) and MACNE (adjusted HR, 1.11 for every doubling in BNP values; 95{\%} CI 1.01 to 1.22) increased with BNP concentration, while the elevated BNP values were not associated with increased risks of major bleeding. BNP values improved the risk prediction of AF progression and MACNE when added to conventional risk estimates. Conclusions BNP levels are associated with increased risk of AF progression and cardiovascular outcomes in patients with AF. Further studies are required to assess whether biomarker-based risk stratification improves patient outcomes. Clinical trial registration NCT01701817.",
author = "Taku Inohara and Sunghee Kim and Karen Pieper and Blanco, {Rosalia G.} and Allen, {Larry A.} and Fonarow, {Gregg C.} and Gersh, {Bernard J.} and Ezekowitz, {Michael D.} and Kowey, {Peter R.} and Reiffel, {James A.} and Naccarelli, {Gerald V.} and Chan, {Paul S.} and Mahaffey, {Kenneth W.} and Singer, {Daniel E.} and Freeman, {James V.} and Steinberg, {Benjamin A.} and Peterson, {Eric D.} and Piccini, {Jonathan P.}",
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Inohara, T, Kim, S, Pieper, K, Blanco, RG, Allen, LA, Fonarow, GC, Gersh, BJ, Ezekowitz, MD, Kowey, PR, Reiffel, JA, Naccarelli, GV, Chan, PS, Mahaffey, KW, Singer, DE, Freeman, JV, Steinberg, BA, Peterson, ED & Piccini, JP 2019, 'B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation', Heart, vol. 105, no. 5, pp. 370-377. https://doi.org/10.1136/heartjnl-2018-313642

B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation. / Inohara, Taku; Kim, Sunghee; Pieper, Karen; Blanco, Rosalia G.; Allen, Larry A.; Fonarow, Gregg C.; Gersh, Bernard J.; Ezekowitz, Michael D.; Kowey, Peter R.; Reiffel, James A.; Naccarelli, Gerald V.; Chan, Paul S.; Mahaffey, Kenneth W.; Singer, Daniel E.; Freeman, James V.; Steinberg, Benjamin A.; Peterson, Eric D.; Piccini, Jonathan P.

In: Heart, Vol. 105, No. 5, 01.03.2019, p. 370-377.

Research output: Contribution to journalArticle

TY - JOUR

T1 - B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation

AU - Inohara, Taku

AU - Kim, Sunghee

AU - Pieper, Karen

AU - Blanco, Rosalia G.

AU - Allen, Larry A.

AU - Fonarow, Gregg C.

AU - Gersh, Bernard J.

AU - Ezekowitz, Michael D.

AU - Kowey, Peter R.

AU - Reiffel, James A.

AU - Naccarelli, Gerald V.

AU - Chan, Paul S.

AU - Mahaffey, Kenneth W.

AU - Singer, Daniel E.

AU - Freeman, James V.

AU - Steinberg, Benjamin A.

AU - Peterson, Eric D.

AU - Piccini, Jonathan P.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objective The association with B-type natriuretic peptide (BNP), disease progression and outcomes in patients with atrial fibrillation (AF) has not been thoroughly investigated. Methods We evaluated the association between BNP levels and outcomes, including AF progression, composite outcome of major adverse cardiovascular or neurological events (MACNE) and major bleeding, via pooled logistic regression and Cox frailty models in Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry. AF progression was defined as either paroxysmal becoming persistent or permanent, or persistent becoming permanent at any follow-up. Results Among 13 375 patients with AF, 2797 with BNP values at baseline (median age (IQR), 72.0 (63.0-80.0) years; 43.0% women; median BNP, 238 (102-502) ng/L; 42.3% prior heart failure) were included in the models evaluating the association between BNP levels and MACNE or major bleeding. Of these, 1282 patients with paroxysmal or persistent AF at baseline were analysed in AF progression model. The likelihood of AF progression (adjusted OR, 1.11 for every 100 ng/mL; 95% CI 1.03 to 1.19) and MACNE (adjusted HR, 1.11 for every doubling in BNP values; 95% CI 1.01 to 1.22) increased with BNP concentration, while the elevated BNP values were not associated with increased risks of major bleeding. BNP values improved the risk prediction of AF progression and MACNE when added to conventional risk estimates. Conclusions BNP levels are associated with increased risk of AF progression and cardiovascular outcomes in patients with AF. Further studies are required to assess whether biomarker-based risk stratification improves patient outcomes. Clinical trial registration NCT01701817.

AB - Objective The association with B-type natriuretic peptide (BNP), disease progression and outcomes in patients with atrial fibrillation (AF) has not been thoroughly investigated. Methods We evaluated the association between BNP levels and outcomes, including AF progression, composite outcome of major adverse cardiovascular or neurological events (MACNE) and major bleeding, via pooled logistic regression and Cox frailty models in Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry. AF progression was defined as either paroxysmal becoming persistent or permanent, or persistent becoming permanent at any follow-up. Results Among 13 375 patients with AF, 2797 with BNP values at baseline (median age (IQR), 72.0 (63.0-80.0) years; 43.0% women; median BNP, 238 (102-502) ng/L; 42.3% prior heart failure) were included in the models evaluating the association between BNP levels and MACNE or major bleeding. Of these, 1282 patients with paroxysmal or persistent AF at baseline were analysed in AF progression model. The likelihood of AF progression (adjusted OR, 1.11 for every 100 ng/mL; 95% CI 1.03 to 1.19) and MACNE (adjusted HR, 1.11 for every doubling in BNP values; 95% CI 1.01 to 1.22) increased with BNP concentration, while the elevated BNP values were not associated with increased risks of major bleeding. BNP values improved the risk prediction of AF progression and MACNE when added to conventional risk estimates. Conclusions BNP levels are associated with increased risk of AF progression and cardiovascular outcomes in patients with AF. Further studies are required to assess whether biomarker-based risk stratification improves patient outcomes. Clinical trial registration NCT01701817.

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Inohara T, Kim S, Pieper K, Blanco RG, Allen LA, Fonarow GC et al. B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation. Heart. 2019 Mar 1;105(5):370-377. https://doi.org/10.1136/heartjnl-2018-313642