Assessment of N-terminal pro-B-type natriuretic peptide level in screening for atrial fibrillation in primary health care
Assessment of N-terminal pro-B-type natriuretic peptide level in screening for atrial fibrillation in primary health care
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DOI：
10.1371/journal.pone.0212974
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发表时间：
2019-02-26
期刊：
影响因子：
3.7
通讯作者：
Al-Khalili, Faris
中科院分区：
文献类型：
--
作者：
Ghazal, Faris;Theobald, Holger;Al-Khalili, Faris
心房颤动（AF）是血栓栓塞事件的一个重要原因，通常是无声的和间歇性的，因此对诊断提出了挑战。本研究的目的是评估血浆n端前脑利钠肽（NT-proBNP）水平是否与房颤的存在有关，从而可能用于促进房颤的初级保健筛查方案。方法采用横断面筛选法。在斯德哥尔摩一家初级保健中心登记的70-74岁人群被邀请进行房颤筛查。在2周的时间里，使用手持设备间歇记录心电图，每天两次，每次30秒。在324名参与者中，34名患者已经知道房颤，16名新发房颤患者通过筛查被检测到。检测了已知房颤患者、新发现房颤患者和53名无房颤的对照组的血浆NT-proBNP。研究发现，已知房颤患者的中位NT-proBNP为697 ng/L，新发房颤患者为335 ng/L，无房颤患者为146 ng/L。已知房颤与新发房颤、新发房颤与无房颤患者的NT-proBNP水平中位数差异有统计学意义。新发房颤检测的受试者工作特征曲线下面积为0.68 (95% CI 0.56 ~ 0.79)，分界点为124 ng/L，敏感性75%，特异性45%，阴性预测值86%。结论已知房颤患者血浆NT-proBNP水平高于新发房颤患者，新发房颤患者血浆NT-proBNP水平高于无房颤患者，因此NT-proBNP可能是房颤检测及其持续性的有效筛查指标。
BackgroundAtrial fibrillation (AF), an important cause of thromboembolic events, is often silent and intermittent, thus presenting a diagnostic challenge. The aim of this study was to assess whether the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to the presence of AF and thereby might be used to facilitate screening programs for AF in primary care.MethodsThis was a cross sectional screening study. A population of 70-74-year-old individuals registered at a single primary care center in Stockholm were invited to AF screening. Intermittent ECG recording, 30 seconds twice a day using a hand-held device over 2 weeks, was offered to participants without previously known AF. Of the 324 participating persons, 34 patients had already known AF and 16 new cases of AF were detected by screening. Plasma NT-proBNP was measured in patients with previously known AF, newly detected AF, and 53 control participants without AF.FindingsThe median NT-proBNP was 697 ng/L in patients with previously known AF, 335 ng/L in new cases of AF, and 146 ng/L in patients without AF. After adjustment for several clinical variables and morbidities, the differences of median NT-proBNP levels were statistically significant between cases of previously known AF and new cases of AF as well as between new cases of AF and those without AF. The area under receiver operating characteristic curve of detection of new AF was 0.68 (95% CI 0.56 to 0.79) yielding a cut-off point of 124 ng/L with 75% sensitivity, 45% specificity, and 86% negative predictive value.ConclusionsThe NT-proBNP plasma levels among patients with known AF are higher than those with newly detected AF, and the latter have higher levels than those without AF. Therefore NT-proBNP might be a useful screening marker for the detection of AF and its persistence.