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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01226

N-terminal Pro B-type natriuretic peptide usefulness for paroxysmal atrial fibrillation detection among populations carrying cardiovascular risk factors

 Elena Palà1,  Alejandro Bustamante1, 2*,  Josep L. Clúa-Espuny3, 4, Juan Acosta5, Felipe González3, 4,  Juan Ballesta-Ors3, 4, Natalia Gill1, Andrea Caballero6, Jorge Pagola2, Alonso Pedrote5, Miguel Á. Muñoz3, 4 and Joan Montaner1
  • 1Vall d'Hebron Research Institute (VHIR), Spain
  • 2Department of Neurology, Vall d'Hebron University Hospital, Spain
  • 3Catalan Health Institute, Spain
  • 4University institute of Investigation in Primary Care Jordi Gol, Spain
  • 5Virgen del Rocío University Hospital, Spain
  • 6Vall d'Hebron University Hospital, Spain

Background: Atrial fibrillation (AF) systematic screening studies have not shown a clear usefulness in stroke prevention, as AF might be presented as paroxysmal and asymptomatic. This study aims to determine the usefulness of some blood-biomarkers to identify paroxysmal atrial fibrillation in the context of a screening program.
Methods: 100 subjects between 65-75 years with hypertension and diabetes were randomly selected. AF was assessed by conventional electrocardiogram (ECG) and four weeks monitoring with a wearable Holter device (NuuboTM). N-terminal pro B-type natriuretic peptide (NT-proBNP), Apolipoprotein CIII (ApoC-III), von Willebrand factor (vWF), ADAMTS13, urokinase plasminogen activator surface receptor (uPAR) and urokinase plasminogen activator (uPA) were determined in serum/plasma samples and the levels were compared depending on AF presence and mode of detection.
Results: AF prevalence in the studied population was found to be 20%. In 7 subjects AF was only detected after one-month monitoring (h-AF group). NT-proBNP levels were higher in subjects with AF compared with subjects with no AF (p<0.0001), even when only taking into account h-AF group (p=0.031). No significant differences were found in the other biomarkers. NT-proBNP >95pg/ml cut-off showed high sensitivity and specificity to detect AF (95%, 66.2%) or h-AF (85.72%, 66.2%) and was found to be an independent predictor of AF and h-AF in a logistic regression analysis. NT-proBNP correlates with AF burden (r=0.597, p=0.024).
Conclusion: NT-proBNP was elevated in AF cases not identified with ECG, thus, it may be used as screening biomarker in asymptomatic high risk populations with a promising cut-off point of 95 pg/ml that requires further validation.

Keywords: Stroke, Atrial Fibrillation, biomarker, screening, NT-ProBNP

Received: 16 May 2019; Accepted: 04 Nov 2019.

Copyright: © 2019 Palà, Bustamante, Clúa-Espuny, Acosta, González, Ballesta-Ors, Gill, Caballero, Pagola, Pedrote, Muñoz and Montaner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Alejandro Bustamante, Vall d'Hebron Research Institute (VHIR), Barcelona, 08035, Catalonia, Spain, alejandro.bustamante@vhir.org