Article

The increasing prevalence of atrial fibrillation and novel therapeutic
tools to prevent cardioembolic stroke has increased the need for risk markers.
This study explored the relationship between the midregional sequence
of pro-atrial natriuretic peptide (MR-proANP) levels with the risk of atrial
fibrillation and stroke, and whether measurement of MR-proANP improves the
prediction of these outcomes. Methods MR-proANP was measured in fasting blood
samples of 5130 subjects
(69% men, mean age 69.2 +/- 6.2 years) without a history
of atrial fibrillation or stroke from the general population. The incidence of
atrial fibrillation and stroke was monitored over a median follow-up of 5.6
years. C-statistics and net reclassification improvement was used to assess the
predictive ability of MR-proANP in addition to conventional risk factors. Results
Log-normalized MR-proANP was significantly associated with the incidence of
atrial fibrillation ( n = 362; hazard ratio (HR); 95% confidence interval (CI)
per 1 standard deviation (SD) 2.05, 1.86-2.27) and stroke from all causes ( n =
195; HR 1.30; 95% CI 1.12-1.50). The HR for stroke events related to atrial
fibrillation was 1.79 (95% CI 1.25-2.58) per 1 SD. MR-proANP significantly
improved the prediction of atrial fibrillation when added to a risk score of
conventional risk factors (C statistic 0.69 vs. 0.75), mainly by down-classifying
subjects who did not develop atrial fibrillation. A smaller improvement in
predictive ability was observed for stroke (C statistic 0.66 vs. 0.68).
Conclusion High plasma levels of MR-proANP are associated with the incidence of
atrial fibrillation and stroke in the middle-aged and elderly population.
MR-proANP may be useful to identify individuals with an increased risk of atrial
fibrillation.

Langue : ANGLAIS