The following is a summary of “Heart Failure Risk Assessment Using Biomarkers in Patients With Atrial Fibrillation: Analysis From COMBINE-AF,” published in the October 2024 issue of Cardiology by Haller et al.      

Heart failure (HF) is familiar among patients with atrial fibrillation (AF), making accurate risk assessment clinically meaningful.  

Researchers conducted a prospective study investigating the incremental predictive performance of N-terminal pro–B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and growth differentiation factor 15 (GDF-15) for HF risk stratification in patients with AF.  

They pooled individual patient data from 3 RCTs comparing direct oral anticoagulants (DOACs) with warfarin (ARISTOTLE [Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation], ENGAGE AF-TIMI 48 [Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis In Myocardial Infarction 48], and RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy]) in the cohort of COMBINE-AF, including all patients with available baseline biomarkers. The Cox regression was used for analysis, adjusting for clinical factors, and weighted quantile sum regression analysis to address interbiomarker correlation.  

The results showed 32,041 patients, increased biomarker values were linked with an increase in absolute risk for cardiovascular death (CVD) or hospitalization for heart failure (HHF), HHF, and HF-related death, NT-proBNP (HR per 1 SD: 1.68; 95% CI: 1.59-1.77), hs-cTnT (HR: 1.39; 95% CI: 1.33-1.44), and GDF-15 (HR: 1.20; 95% CI: 1.15-1.25) were significantly associated with CVD/HHF. The discrimination of the clinical model improved substantially upon the addition of the biomarkers (c-index: 0.70 [95% CI: 0.69-0.71] to 0.77 [95% CI: 0.76-0.78]; likelihood ratio test, P<0.001).  

They concluded that NT-proBNP, hs-cTnT, and GDF-15 significantly and independently contributed to HF risk stratification in patients with AF, supporting the potential future use of biomarkers to identify patients at low or high risk for HF.  

Source: jacc.org/doi/10.1016/j.jacc.2024.07.023