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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 ( IF 2.0 ) Pub Date : 2021-09-16 , DOI: 10.1186/s12872-021-02254-5
Willy Weng 1 , Rajin Choudhury 2 , John Sapp 2 , Anthony Tang 3 , Jeff S Healey 4 , Isabelle Nault 5 , Lena Rivard 6 , Isabelle Greiss 7 , Jordan Bernick 1 , Ratika Parkash 2
Affiliation  

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). 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. 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). 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.

中文翻译:

脑利钠肽在心房颤动中的作用:心房颤动 (SMAC-AF) 试验的基质改良与积极血压控制的子研究

导管消融是房颤的既定疗法,但受到复发的限制;已经努力确定预测复发的生物标志物。我们调查了基线 NT-proBNP 对导管消融后房颤复发的影响,患者随机接受积极(< 120/80 mmHg)或标准血压管理(< 140/90 mmHg)在基质改良和积极血压控制试验中的影响。 SMAC-AF)。SMAC-AF 研究包括 173 名对至少一种 I 或 III 类抗心律失常药物耐药或不耐受的患者。我们研究了基线 NT-proBNP 对消融后 3 个月以上 AF 复发的主要结果的影响。在 173 名患者中,88 人被随机分配到积极组,85 人被随机分配到标准组。主要结果发生在 61.4% 的积极组中,而标准组为 61.2%。在积极组中,logNT-proBNP 预测复发(HR 1.28,p = 0.04,调整后 HR 1.43,p = 0.03),而在标准组中,它没有预测复发(HR 0.94,p = 0.62,调整后 HR 0.83,p = 0.22)。NT-proBNP ≥ 280 pg/mL 也预测了侵袭性(HR 1.98,p = 0.02)但不预测标准队列(HR 1.00,p = 1.00)的发生。我们得出结论,消融前 NT-proBNP 可能有助于预测高血压患者的复发,并确定受益于积极血液控制和上游治疗的患者。试用注册号:NCT004381​​13,2007年2月21日注册。NT-proBNP ≥ 280 pg/mL 也预测了侵袭性(HR 1.98,p = 0.02)但不预测标准队列(HR 1.00,p = 1.00)的发生。我们得出结论,消融前 NT-proBNP 可能有助于预测高血压患者的复发,并确定受益于积极血液控制和上游治疗的患者。试用注册号:NCT004381​​13,2007年2月21日注册。NT-proBNP ≥ 280 pg/mL 也预测了侵袭性(HR 1.98,p = 0.02)但不预测标准队列(HR 1.00,p = 1.00)的发生。我们得出结论,消融前 NT-proBNP 可能有助于预测高血压患者的复发,并确定受益于积极血液控制和上游治疗的患者。试用注册号:NCT004381​​13,2007年2月21日注册。
更新日期:2021-09-17
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