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The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure.

Bernadet T Santema 1 Michelle M y Chan 2, 3 Jasper Tromp 1, 2, 3 Martin Dokter 4, 1 Haye H van Der Wal 1 Johanna E Emmens 1 Janny Takens 1 Nilesh J Samani 5 Leong L Ng 5 Chim C Lang 6, 7 Peter van Der Meer 1 Jozine M ter Maaten 1 Kevin Damman 1 Kenneth Dickstein 8, 9 John G Cleland 10, 11 Faiez Zannad 12, 13, 14, 15 Stefan D Anker 16, 17, 18 Marco Metra 19 Pim van Der Harst 1 Rudolf A de Boer 1 Dirk J van Veldhuisen 1 Michiel Rienstra 1 Carolyn S P Lam 1, 2, 3 Adriaan A Voors 1 
Abstract : Background: In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods: In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results: Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th-75th percentile 1897-6486] versus 1788 [682-3870], adjusted p < 0.001, versus 2231 pg/mL [902-5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062-5253] versus 2545 [1686-4337], adjusted p = 0.36, versus 2294 [1471-3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion: These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF.
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Submitted on : Tuesday, November 24, 2020 - 4:09:58 PM
Last modification on : Tuesday, January 18, 2022 - 2:26:07 PM
Long-term archiving on: : Thursday, February 25, 2021 - 8:35:28 PM


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Bernadet T Santema, Michelle M y Chan, Jasper Tromp, Martin Dokter, Haye H van Der Wal, et al.. The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure.. Clinical Research in Cardiology, Springer Verlag, 2020, 109 (3), pp.331-338. ⟨10.1007/s00392-019-01513-y⟩. ⟨hal-03022072⟩



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