Supraventricular arrhythmia, N-terminal pro-brain natriuretic peptide and troponin T concentration in relation to incidence of atrial fibrillation: a prospective cohort study

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; pp. 134 - 9
• Main Authors: Xiao, Jun, Persson, Anders P., Engström, Gunnar, Johnson, Linda S. B.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.03.2021; BioMed Central; BMC
• Subjects: Age; Antihypertensives; Arrhythmia; Atrial fibrillation; Biomarkers; Blood pressure; Brain natriuretic peptide; Calcium-binding protein; Cardiac and Cardiovascular Systems; Cardiac arrhythmia; Cardiology and Cardiovascular Disease; Clinical Medicine; Cohort analysis; Complications and side effects; Diabetes; Diagnosis; Electrocardiography; Fibrillation; Health aspects; Heart failure; Hospitals; Insulin resistance; Kardiologi; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Natriuretic peptides; NT-proBNP; Peptides; Plasma levels; Population; Population distribution; Population studies; Predictions; Premature atrial contractions; Risk assessment; Risk factors; Stroke; Supraventricular extrasystole; Supraventricular tachycardia; Troponin; Troponin T; Sweden; Premature atrial contractions; NT-proBNP; Supraventricular tachycardia; Supraventricular extrasystole; Atrial fibrillation; Troponin T
• DOI: 10.1186/s12872-021-01942-6
• ISSN: 1471-2261

Frequent supraventricular arrhythmia is associated with increased incidence of atrial fibrillation. However, it is unknown whether the prognostic significance of supraventricular arrhythmia is modified by plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) or troponin T (TnT). This study examined the interrelationships between NT-proBNP, TnT levels and frequent supraventricular arrhythmia, and whether these biomarkers and a measure of frequent supraventricular arrhythmia could improve risk assessment for incidence of AF. Supraventricular extrasystoles (SVEs) and supraventricular tachycardias were assessed from 24-h electrocardiograph recordings in 373 individuals initially without AF. Elevated NT-pro-BNP, TnT and SVEs was defined as a measurement in the top quartile of the study population distribution. Incident cases of AF were retrieved by linkage with the Swedish National Patient Register. During a mean follow-up of 15.4 years, 88 subjects had a diagnosis of AF. After multivariable adjustment, individuals with both elevated NT-proBNP and frequent SVEs had a significantly increased incidence of AF, compared to subjects without elevated NT-proBNP or frequent SVEs (hazard ratio (HR) 4.61, 95% confidence interval (CI) 2.45-8.69), and compared to individuals with either elevated NT-proBNP or frequent SVEs (both P < 0.05). HRs for frequent SVEs alone or elevated NT-proBNP alone were 2.32 (95% CI 1.33-4.06) and 1.52 (95% CI 0.76-3.05), respectively. The addition of NT-pro-BNP and SVEs to a validated risk prediction score for AF, CHARGE-AF, resulted in improved prediction (Harrell's C 0.751 (95% CI 0.702-0.799) vs 0.720 (95% CI 0.669-0.771), P = 0.015). Subjects with both elevated NT-proBNP and frequent SVEs have substantially increased risk of AF, and the use of these variables could improve long-term prediction of incident AF.