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Abstract：
Background Patients with atrial fibrillation (AF) face an increased risk of death and major adverse cardiovascular events (MACE). We aimed to assess the predictive value of the novel atrial-specific biomarker BMP10 (bone morphogenetic protein 10) for death and MACE in patients with AF in comparison with NT-proBNP (N-terminal prohormone of B-type natriuretic peptide). Methods and Results BMP10 and NT-proBNP were measured in patients with AF enrolled in Swiss-AF (Swiss Atrial Fibrillation Study), a prospective multicenter cohort study. A total of 2219 patients were included (median follow-up 4.3 years [interquartile range 3.9, 5.1], mean age 73±9 years, 73% male). In multivariable Cox proportional hazard models, the adjusted hazard ratio (aHR) associated with 1 ng/mL increase of BMP10 was 1.60 (95% CI, 1.37-1.87) for all-cause death, and 1.54 (95% CI, 1.35-1.76) for MACE. For all-cause death, the concordance index was 0.783 (95% CI, 0.763-0.809) for BMP10, 0.784 (95% CI, 0.765-0.810) for NT-proBNP, and 0.789 (95% CI, 0.771-0.815) for both biomarkers combined. For MACE, the concordance index was 0.732 (95% CI, 0.715-0.754) for BMP10, 0.747 (95% CI, 0.731-0.768) for NT-proBNP, and 0.750 (95% CI, 0.734-0.771) for both biomarkers combined. When grouping patients according to NT-proBNP categories (<300, 300-900, >900 ng/L), higher aHRs were observed in patients with high BMP10 in the categories of low NT-proBNP (all-cause death aHR, 2.28 [95% CI, 1.15-4.52], MACE aHR, 1.88 [95% CI, 1.07-3.28]) and high NT-proBNP (all-cause death aHR, 1.61 [95% CI, 1.14-2.26], MACE aHR, 1.38 [95% CI, 1.07-1.80]). Conclusions BMP10 strongly predicted all-cause death and MACE in patients with AF. BMP10 provided additional prognostic information in low- and high-risk patients according to NT-proBNP stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
摘要：
背景：房颤（AF）患者面临死亡和主要不良心血管事件（MACE）的风险增加。我们旨在评估新型心房特异性生物标志物BMP10（骨形态发生蛋白10）与NT-proBNP（B型利钠肽的N末端激素原）相比对房颤患者死亡和MACE的预测价值。方法和结果在瑞士房颤（瑞士房颤研究）的房颤患者中测量BMP10和NT-proBNP，前瞻性多中心队列研究。共纳入2219例患者（中位随访4.3年[四分位距3.9，5.1]，平均年龄73±9岁，73%男性）。在多变量Cox比例风险模型中，对于全因死亡，与BMP10增加1ng/mL相关的校正风险比（aHR）为1.60（95％CI，1.37-1.87），MACE为1.54（95%CI，1.35-1.76）。对于全因死亡，BMP10的一致性指数为0.783（95％CI，0.763-0.809），NT-proBNP为0.784（95％CI，0.765-0.810），和0.789（95%CI，0.771-0.815）两种生物标志物的组合。对于MACE，BMP10的一致性指数为0.732（95％CI，0.715-0.754），NT-proBNP为0.747（95％CI，0.731-0.768），和0.750（95%CI，0.734-0.771）两种生物标志物的组合。当根据NT-proBNP类别（<300，300-900，>900ng/L）对患者进行分组时，在低NT-proBNP（全因死亡aHR，2.28[95%CI，1.15-4.52]，MACEAHR，1.88[95%CI，1.07-3.28])和高NT-proBNP(全因死亡aHR，1.61[95%CI，1.14-2.26]，MACEAHR，1.38[95%CI，1.07-1.80]）。结论BMP10能强烈预测房颤患者的全因死亡和MACE。根据NT-proBNP分层，BMP10在低风险和高风险患者中提供了额外的预后信息。注册网址：https://www。clinicaltrials.gov；唯一标识符：NCT02105844。
