NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients: A prospective clinical study

Cecilie Budolfsen; Anders Sjørslev Schmidt; Kasper Glerup Lauridsen; Camilla Bang Hoeks; Farhad Waziri; Christian Bo Poulsen; Dung Nguyen Riis; Hans Rickers; Bo Løfgren

doi:10.1016/j.ajem.2023.05.041

NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients: A prospective clinical study

Cecilie Budolfsen, Anders Sjørslev Schmidt, Kasper Glerup Lauridsen, Camilla Bang Hoeks, Farhad Waziri, Christian Bo Poulsen, Dung Nguyen Riis, Hans Rickers, Bo Løfgren^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

3 Citations (Scopus)

Abstract

Study objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements can be used to rule out heart failure in patients with sinus rhythm. Atrial fibrillation often coexists with heart failure but affects NT-proBNP levels. This study aims to identify the optimal NT-proBNP cut-off value for ruling out heart failure among atrial fibrillation patients. Methods: This prospective study included 409 atrial fibrillation patients admitted to the emergency department. The inclusion criterion was documented atrial fibrillation on a 12‑lead electrocardiogram. All patients completed a NT-proBNP blood sample, a chest X-ray and an echocardiogram. Heart failure was defined as a left ventricular ejection fraction of <40%. Results: In total, 409 patients were included (mean age: 75.2 ± 11.6). The median NT-proBNP level was 2577 ng/L (quartiles: 1185-5438) and 21% had heart failure. We found a lower median NT proBNP level of 3187 ± 3973 ng/L in patients without heart failure compared to 9254 ± 8008 ng/L in patients with heart failure (absolute difference: 4131, 95% (CI): 3299-4986, p < 0.001). The area under the receiver operating characteristic curve for diagnosing heart failure was 0.82 (95% confidence interval: 0.77–0.87). The optimal cut-off value for ruling out heart failure was 739 ng/L with a sensitivity of 99%, a specificity of 18%, and a negative predictive value of 98%. Conclusions: NT-proBNP can be used to rule out heart failure in atrial fibrillation patients with a high negative predictive value, but low specificity. Trial registration number: NCT04125966. https://clinicaltrials.gov/ct2/show/NCT04125966.

Original language	English
Journal	American Journal of Emergency Medicine
Volume	71
Pages (from-to)	18-24
Number of pages	7
ISSN	0735-6757
DOIs	https://doi.org/10.1016/j.ajem.2023.05.041
Publication status	Published - Sept 2023

Keywords

Atrial fibrillation
Biomarker
Emergency department
Heart failure
NT-proBNP

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10.1016/j.ajem.2023.05.041

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@article{07e85982e59d47178b9102a5913aa7cf,

title = "NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients: A prospective clinical study",

abstract = "Study objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements can be used to rule out heart failure in patients with sinus rhythm. Atrial fibrillation often coexists with heart failure but affects NT-proBNP levels. This study aims to identify the optimal NT-proBNP cut-off value for ruling out heart failure among atrial fibrillation patients. Methods: This prospective study included 409 atrial fibrillation patients admitted to the emergency department. The inclusion criterion was documented atrial fibrillation on a 12‑lead electrocardiogram. All patients completed a NT-proBNP blood sample, a chest X-ray and an echocardiogram. Heart failure was defined as a left ventricular ejection fraction of <40%. Results: In total, 409 patients were included (mean age: 75.2 ± 11.6). The median NT-proBNP level was 2577 ng/L (quartiles: 1185-5438) and 21% had heart failure. We found a lower median NT proBNP level of 3187 ± 3973 ng/L in patients without heart failure compared to 9254 ± 8008 ng/L in patients with heart failure (absolute difference: 4131, 95% (CI): 3299-4986, p < 0.001). The area under the receiver operating characteristic curve for diagnosing heart failure was 0.82 (95% confidence interval: 0.77–0.87). The optimal cut-off value for ruling out heart failure was 739 ng/L with a sensitivity of 99%, a specificity of 18%, and a negative predictive value of 98%. Conclusions: NT-proBNP can be used to rule out heart failure in atrial fibrillation patients with a high negative predictive value, but low specificity. Trial registration number: NCT04125966. https://clinicaltrials.gov/ct2/show/NCT04125966.",

keywords = "Atrial fibrillation, Biomarker, Emergency department, Heart failure, NT-proBNP",

author = "Cecilie Budolfsen and Schmidt, {Anders Sj{\o}rslev} and Lauridsen, {Kasper Glerup} and Hoeks, {Camilla Bang} and Farhad Waziri and Poulsen, {Christian Bo} and Riis, {Dung Nguyen} and Hans Rickers and Bo L{\o}fgren",

year = "2023",

month = sep,

doi = "10.1016/j.ajem.2023.05.041",

language = "English",

volume = "71",

pages = "18--24",

journal = "American Journal of Emergency Medicine",

issn = "0735-6757",

publisher = "W.B. Saunders",

}

NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients: A prospective clinical study. / Budolfsen, Cecilie; Schmidt, Anders Sjørslev; Lauridsen, Kasper Glerup et al.
In: American Journal of Emergency Medicine, Vol. 71, 09.2023, p. 18-24.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients

T2 - A prospective clinical study

AU - Budolfsen, Cecilie

AU - Schmidt, Anders Sjørslev

AU - Lauridsen, Kasper Glerup

AU - Hoeks, Camilla Bang

AU - Waziri, Farhad

AU - Poulsen, Christian Bo

AU - Riis, Dung Nguyen

AU - Rickers, Hans

AU - Løfgren, Bo

PY - 2023/9

Y1 - 2023/9

N2 - Study objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements can be used to rule out heart failure in patients with sinus rhythm. Atrial fibrillation often coexists with heart failure but affects NT-proBNP levels. This study aims to identify the optimal NT-proBNP cut-off value for ruling out heart failure among atrial fibrillation patients. Methods: This prospective study included 409 atrial fibrillation patients admitted to the emergency department. The inclusion criterion was documented atrial fibrillation on a 12‑lead electrocardiogram. All patients completed a NT-proBNP blood sample, a chest X-ray and an echocardiogram. Heart failure was defined as a left ventricular ejection fraction of <40%. Results: In total, 409 patients were included (mean age: 75.2 ± 11.6). The median NT-proBNP level was 2577 ng/L (quartiles: 1185-5438) and 21% had heart failure. We found a lower median NT proBNP level of 3187 ± 3973 ng/L in patients without heart failure compared to 9254 ± 8008 ng/L in patients with heart failure (absolute difference: 4131, 95% (CI): 3299-4986, p < 0.001). The area under the receiver operating characteristic curve for diagnosing heart failure was 0.82 (95% confidence interval: 0.77–0.87). The optimal cut-off value for ruling out heart failure was 739 ng/L with a sensitivity of 99%, a specificity of 18%, and a negative predictive value of 98%. Conclusions: NT-proBNP can be used to rule out heart failure in atrial fibrillation patients with a high negative predictive value, but low specificity. Trial registration number: NCT04125966. https://clinicaltrials.gov/ct2/show/NCT04125966.

AB - Study objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements can be used to rule out heart failure in patients with sinus rhythm. Atrial fibrillation often coexists with heart failure but affects NT-proBNP levels. This study aims to identify the optimal NT-proBNP cut-off value for ruling out heart failure among atrial fibrillation patients. Methods: This prospective study included 409 atrial fibrillation patients admitted to the emergency department. The inclusion criterion was documented atrial fibrillation on a 12‑lead electrocardiogram. All patients completed a NT-proBNP blood sample, a chest X-ray and an echocardiogram. Heart failure was defined as a left ventricular ejection fraction of <40%. Results: In total, 409 patients were included (mean age: 75.2 ± 11.6). The median NT-proBNP level was 2577 ng/L (quartiles: 1185-5438) and 21% had heart failure. We found a lower median NT proBNP level of 3187 ± 3973 ng/L in patients without heart failure compared to 9254 ± 8008 ng/L in patients with heart failure (absolute difference: 4131, 95% (CI): 3299-4986, p < 0.001). The area under the receiver operating characteristic curve for diagnosing heart failure was 0.82 (95% confidence interval: 0.77–0.87). The optimal cut-off value for ruling out heart failure was 739 ng/L with a sensitivity of 99%, a specificity of 18%, and a negative predictive value of 98%. Conclusions: NT-proBNP can be used to rule out heart failure in atrial fibrillation patients with a high negative predictive value, but low specificity. Trial registration number: NCT04125966. https://clinicaltrials.gov/ct2/show/NCT04125966.

KW - Atrial fibrillation

KW - Biomarker

KW - Emergency department

KW - Heart failure

KW - NT-proBNP

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U2 - 10.1016/j.ajem.2023.05.041

DO - 10.1016/j.ajem.2023.05.041

M3 - Journal article

C2 - 37320999

AN - SCOPUS:85161645315

SN - 0735-6757

VL - 71

SP - 18

EP - 24

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

ER -

NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients: A prospective clinical study

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