Abstract
BackgroundFrequent 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.MethodsSupraventricular 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.ResultsDuring 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).ConclusionSubjects 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.
Highlights
Atrial fibrillation (AF) is the most common sustained arrhythmia, especially among the elderly, and is associated with increased mortality and morbidity [1,2,3]
Supraventricular arrhythmias and incidence of AF During a mean follow-up time of 15.4 years, 88 subjects were diagnosed with AF
After multivariable adjustment NTproBNP and troponin T (TnT) were related to the number of supraventricular extrasystoles (SVEs) in 24 h (Odds ratio (OR)NT-proBNP = 1.64, 95% confidential interval (CI) 1.33–2.02; O RTnT = 1.33, 95% Confidence interval (CI) 1.10–1.60, both per quartile increase; Additional file 1: Supplementary Table 1)
Summary
Atrial fibrillation (AF) is the most common sustained arrhythmia, especially among the elderly, and is associated with increased mortality and morbidity [1,2,3]. Structural remodeling includes atrial dilation and myocardial damage This may result in elevated N-terminal pro-brain natriuretic peptide (NTproBNP) and troponin T (TnT) [8, 9], both of which have been linked to a greater risk of AF [10, 11]. Electrical remodeling, on the other hand, can be measured by increased frequency of supraventricular extrasystoles (SVEs) and supraventricular tachycardias (SVTs), which are highly related to AF risk [12,13,14,15,16] It is plausible, that subjects with both elevated NT-pro-BNP or TnT and frequent supraventricular extrasystoles could have substantially increased risk of AF. Frequent supraventricular arrhythmia is associated with increased incidence of atrial fibrillation 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
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