Lessons Learned and to Be Learned About the Use of N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure and Atrial Fibrillation
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See Article by Kristensen et al
Natriuretic peptides (NPs) are the most established biomarkers in heart failure (HF), routinely used for both their diagnostic and prognostic use in clinical management and clinical trials. It has been consistently shown that levels of NPs are higher in patients with HF who also have atrial fibrillation (AF), compared with those in sinus rhythm. One the one hand, higher NP levels may reflect more advanced HF in patients with concurrent AF. On the other hand, AF itself might cause elevations of NPs, even in the absence of HF.
Irrespective of the cause of higher levels of NPs in patients with both HF and AF, higher NP thresholds are frequently applied to these patients to qualify them for entry into HF clinical trials, compared with patients with HF without AF. But are these different NP thresholds really needed? Kristensen et al1 pooled data from 2 large HF clinical trials (PARADIGM-HF [Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial] and ATMOSPHERE [Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure]), yielding data on the prognostic value of NT-proBNP (N-terminal pro-B-type natriuretic peptide) in 14 737 patients with chronic HF with reduced ejection fraction. The aim of this analysis was to compare the prognostic value of NT-proBNP in patients with and without AF. Interestingly, except in the range <400 pg/mL, the prognostic value of NT-proBNP for a given level was similar in patients with and without AF. Based on the present findings, the authors suggest that these …