The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial
Abstract Background Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients rando...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-021-02254-5 |
| _version_ | 1818365057492320256 |
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| author | Willy Weng Rajin Choudhury John Sapp Anthony Tang Jeff S. Healey Isabelle Nault Lena Rivard Isabelle Greiss Jordan Bernick Ratika Parkash |
| author_facet | Willy Weng Rajin Choudhury John Sapp Anthony Tang Jeff S. Healey Isabelle Nault Lena Rivard Isabelle Greiss Jordan Bernick Ratika Parkash |
| author_sort | Willy Weng |
| collection | DOAJ |
| description | Abstract Background Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF). Methods The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation. Results Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00). Conclusion We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies. Trial registration: NCT00438113, registered February 21, 2007. |
| first_indexed | 2024-12-13T22:14:13Z |
| format | Article |
| id | doaj.art-2bf61f8999f24dd4a2f01cf8af3fe4e1 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-13T22:14:13Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-2bf61f8999f24dd4a2f01cf8af3fe4e12022-12-21T23:29:38ZengBMCBMC Cardiovascular Disorders1471-22612021-09-012111810.1186/s12872-021-02254-5The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trialWilly Weng0Rajin Choudhury1John Sapp2Anthony Tang3Jeff S. Healey4Isabelle Nault5Lena Rivard6Isabelle Greiss7Jordan Bernick8Ratika Parkash9University of Ottawa Heart InstituteDalhousie UniversityDalhousie UniversityWestern UniversityMcMaster UniversityUniversité LavalMontreal Heart InstituteCentre Hospitalier de L’Université de MontréalUniversity of Ottawa Heart InstituteDalhousie UniversityAbstract Background Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF). Methods The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation. Results Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00). Conclusion We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies. Trial registration: NCT00438113, registered February 21, 2007.https://doi.org/10.1186/s12872-021-02254-5Atrial fibrillationCatheter ablationRecurrenceBiomarker |
| spellingShingle | Willy Weng Rajin Choudhury John Sapp Anthony Tang Jeff S. Healey Isabelle Nault Lena Rivard Isabelle Greiss Jordan Bernick Ratika Parkash The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial BMC Cardiovascular Disorders Atrial fibrillation Catheter ablation Recurrence Biomarker |
| title | The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial |
| title_full | The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial |
| title_fullStr | The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial |
| title_full_unstemmed | The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial |
| title_short | The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial |
| title_sort | role of brain natriuretic peptide in atrial fibrillation a substudy of the substrate modification with aggressive blood pressure control for atrial fibrillation smac af trial |
| topic | Atrial fibrillation Catheter ablation Recurrence Biomarker |
| url | https://doi.org/10.1186/s12872-021-02254-5 |
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