Steady-state B-type natriuretic peptide levels in patients with atrial fibrillation of various clinical backgrounds

The relationship between the nutritional status and sleep quality of patients with atrial fibrillation

Objectives:

To evaluate the relationship between the nutritional status and sleep quality in patients diagnosed with atrial fibrillation as a cross-sectional correlational research.

Methods:

This cross-sectional correlational research was carried out with 108 patients between December 2017 and March 2018 who were admitted to the cardiology services of 2 different universities, diagnosed with atrial fibrillation and agreed to participate. Data collection was performed using internationally valid scales in order to evaluate the relationship between the nutritional status and sleep quality of patients diagnosed with atrial fibrillation.

Results:

Of the patients, 47.2% were men and 52.8% were women. Most of them (81.5%) were over the age of 60 years. The mean age was 68.99±14.02. Of the patients, 13% were malnourished, 57.4% were at risk of malnutrition, and 29.6% had a normal nutritional status. This study determined that their sleep quality worsened and their daytime sleepiness increased as their risk of malnutrition increased (p=0.000).

Conclusion:

The patients’ sleep quality worsened and their daytime sleepiness increased as the risk of malnutrition increased.

Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population - Comparisons With C-Reactive Protein and Urinary Albumin

BACKGROUND

The ability of cardiovascular biomarkers to predict the incidence of stroke subtypes remains ill-defined in the general population.Methods and Results:The blood levels of B-type natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) and urinary albumin corrected by urinary creatinine (UACR) were determined in a general population (n=13,575). The ability to predict the incidence of ischemic stroke subtypes (lacunar, atherothrombotic, cardioembolic) for each biomarker was assessed based on the area under the receiver-operating characteristic curve (AUC-ROC) and using Cox proportional hazard modeling. The predictive abilities of UACR and hs-CRP for any subtype of ischemic event were found to be suboptimal. However, the ability of BNP to predict the incidence of cardioembolic stroke was excellent (AUC-ROC=0.81). When BNP was added to established stroke risk factors, the ability to predict cardioembolic stroke in terms of the AUC-ROC significantly improved (4-year follow-up, P=0.018; 8-year follow-up, P=0.009). Furthermore, when BNP was added to the JPHC score, the ability to predict cardioembolic stroke was significantly improved (net reclassification improvement=0.968, P<0.0001: integrated discrimination improvement=0.039, P<0.05).

CONCLUSIONS

In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.

Plasma B-type natriuretic peptide as a predictor of cardiovascular events in subjects with atrial fibrillation: a community-based study

Objectives

Atrial fibrillation (AF) is a significant public health issue due to its high prevalence in the general population, and is associated with an increased risk of cardiovascular (CV) events including systemic thrombo-embolism, heart failure, and coronary artery disease. The relationship between plasma B-type natriuretic peptide (BNP) and CV risk in real world AF subjects remains unknown.

Methods

The subject of the study (n = 228; mean age = 69 years) was unselected individuals with AF in a community-based population (n = 15,394; AF prevalence rate = 1.5%). The CV event free rate within each BNP tertile was estimated, and Cox regression analysis was performed to examine the relative risk of the onset of CV events among the tertiles. The prognostic ability of BNP was compared to an established risk score for embolic events (CHADS2 score). In addition, to determine the usefulness of BNP as a predictor in addition to CHADS2 score, we calculated Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices.

Results

During the follow-up period 58 subjects experienced CV events (52 per 1,000 person-years). The event-free ratio was significantly lower in the highest tertile (p < 0.02). After adjustment for established CV risk factors, the hazard ratio (HR) of the highest tertile was significantly higher than that of the lowest tertile (HR = 2.38; p < 0.02). The predictive abilities of plasma BNP in terms of sensitivity and specificity for general CV events were comparable to those of CHADS2 score. Adding BNP to the CHADS2 score only model improved the NRI (0.319; p < 0.05) and the IDI (0.046; p < 0.05).

Conclusion

Plasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general CV risk including stroke, heart failure and acute coronary syndrome in real-world AF subjects.