Total NT-proBNP: a candidate biomarker for refined diagnosis and prognosis in atrial fibrillation

Listen to a mini-seminar from Professor Latini
Biomarker insights from GISSI‑AF

In this interview, Professor Roberto Latini, from Mario Negri Institute for Pharmacological Research (Head of the Cardiovascular Clinical Pharmacology Laboratory), shares key insights from the biomarker analyses performed in the GISSI-AF study1

The study aimed to understand the prognostic value of N‑terminal pro‑B type natriuretic peptide (NT‑proBNP) glycosylation in atrial fibrillation (AF).


The study1 


A panel of biomarkers, including total NT-proBNP, NT-proBNP, angiopoietin2 (Ang2), and bone morphogenic protein‑10 (BMP10), were evaluated at baseline, 6 months and 12 months in patients with a history of AF that were in sinus rhythm at the time of inclusion. Biomarker measurements were used to analyze the association of the biomarker with ongoing AF, and to predict the recurrence of AF as well as hospitalization for cardiovascular (CV) reasons.


Main findings1


The biomarker analysis highlighted that total NT-proBNP and NT-proBNP, as well as Ang2 and BMP10, were strongly associated with ongoing AF.

Of note, patients with elevated natriuretic peptide levels (total NT-proBNP and NT-proBNP) had a significantly higher risk of developing incident new occurrence of AF, with baseline biomarker levels of total NT-proBNP and NT-proBNP able to predict AF recurrence and CV hospitalization.

Professor Latini underlined that in patients with paroxysmal AF that are at an increased risk of stroke, currently the highest unmet medical need is to have a biomarker supporting secondary prevention by predicting AF recurrence or identifying patients at risk of recurrence. However, to date, no single biomarker has been identified that predicts AF recurrence sufficiently well enough, highlighting the need for more studies to identify and analyze such biomarkers.

Key facts
  • GISSI-AF assessed the association between and the predictive power of plasma concentrations of total NT-proBNP for AF in a cohort of patients with a history of AF, in sinus rhythm, that are at high risk of AF recurrence
  • The association of total NT-proBNP with ongoing AF, the risk of first AF recurrence, and the risk of first hospitalization for CV reasons is similar to that of NT-proBNP, suggesting no influence of NT-proBNP glycosylation
  • The highest unmet medical need is to identify a biomarker that reliably predicts recurrence of AF episodes to support secondary prevention in patients with paroxysmal AF 

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  1. Staszewsky L, et al. Total NT-proBNP, a novel biomarker related to recurrent atrial fibrillation. BMC Cardiovasc Disord. 2021;21:553.