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。