Abstract 19610: Nt-probnp for the Diagnosis of Paroxysmal Atrial Fibrillation in Patients With Ischemic Stroke – The Prospective Find-af Trial
Diagnosis of paroxysmal atrial fibrillation is difficult, but highly relevant in patients presenting with ischemic stroke, but without atrial fibrillation on admission as an effective therapy (anticoagulation) is available. Natriuretic peptides (e. g. NT-proBNP) have been shown to be elevated in patients with paroxysmal atrial fibrllation. We therefore aimed to investigate whether NT-proBNP may help in identifying patients with ischemic cerebral event and paroxysmal atrial fibrillation.
Methods: In the prospective Find-AF trial (ISRCTN 46104198), consecutive patients presenting with cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7 day Holter monitoring, initiated early (median 5.5 h) after the ischemic event. The primary endpoint of this study was the level of NT-proBNP at admission. We prospectively hypothesized, that patients with NT-proBNP > median were more likely to have paroxysmal atrial fibrillation (longer than 30 s) than patients with NT-proBNp< median.
Results: 281 patients were included, of whom 44 (15.7 %) presented in atrial fibrillation. The remaining 237 patients received Holter monitors. The detection rate with early and prolonged Holter monitoring was 12.2 %. In patients with NT-proBNP > median (265 pg/ml), 19.4 % had paroxysmal atrial fibrillation in contrast to 6.7 % with NT-proBNP < 265 pg/ml (p=0.008). The ratio of early (0h) to late (24h) plasma levels of NT-proBNP were not different between patients with and without paroxysmal atrial fibrillation. ROC analysis revealed an area under the curve (ROC) for NT-proBNP of 0.658 in all patients and a ROC of 0.901 in patients <= 60 years to detect paroxysmal atrial fibrillation Conclusions In patients with elevated NT-proBNP levels and stroke on admission, the prevalence of paroxysmal atrial fibrillation is significantly higher. Diagnostic properties of NT-proBNP are moderate in the overall population, but very good in young patients (<=60 years). NT-proBNP should be considered in young persons with ischemic stroke and suspected paroxysmal atrial fibrillation.
- © 2010 by American Heart Association, Inc.