The following is a summary of “NT-proBNP cut-off value for ruling out heart failure in atrial fibrillation patients – A prospective clinical study,” published in the September 2023 issue of Emergency Medicine by Budolfsen, et al.

For a study, researchers sought to determine the optimal N-terminal pro-brain natriuretic peptide (NT-proBNP) cutoff value for effectively excluding heart failure in patients with atrial fibrillation.

The study prospectively enrolled 409 atrial fibrillation patients admitted to the emergency department. Inclusion criteria required documented atrial fibrillation on a 12-lead electrocardiogram. All patients underwent NT-proBNP blood sampling, a chest X-ray, and an echocardiogram. Heart failure was defined as having a left ventricular ejection fraction of less than 40%.

Of the 409 patients included in the study (mean age: 75.2 ± 11.6 years), 21% were diagnosed with heart failure. Patients without heart failure exhibited a lower median NT-proBNP level of 3,187 ± 3,973 ng/L, whereas patients with heart failure had a higher level of 9,254 ± 8,008 ng/L (absolute difference: 4,131, 95% CI: 3,299-4,986, P < 0.001). The area under the receiver operating characteristic curve for heart failure diagnosis was 0.82 (95% CI: 0.77–0.87). The optimal cutoff value for excluding heart failure was 739 ng/L, providing a sensitivity of 99%, specificity of 18%, and a negative predictive value of 98%.

NT-proBNP can be a valuable tool for excluding heart failure in atrial fibrillation patients, mainly due to its high negative predictive value, although it exhibits lower specificity.

Source: sciencedirect.com/science/article/abs/pii/S0735675723002917