Modeling the clinical profile of patients with hypertension and atrial fibrillation by serum NTpro-BNP levels

Abstract

Background. Hypertension and atrial fibrillation are a fairly common combination of heart pathology that occurs in the daily practice of a cardiologist. Associations of clinical laboratory and instrumental indicators with the levels of various biomarkers, in particular serum N-terminal fragment of brain natriuretic propeptide (NT-proBNP), are interesting and promising for scientific research and practical application.

The aim of the study was to simulate the clinical profiles of patients with hypertension and atrial fibrillation depending on the serum levels of NTpro-BNP.

Materials & Methods. 89 patients with stage II hypertension and various clinical forms of atrial fibrillation were included in the study. All patients underwent a general clinical examination, additional determination of NT-proBNP serum levels, and assessment of quality of life according to the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for 2–3 days of hospital stay at against the background of selection of optimal therapy. Sequential statistical processing of the obtained data using Spearman’s rank correlation analysis and multiple linear regression made it possible to create two clinical profiles of patients.

Results & conclusions. Thus, with a relatively high serum level of NTpro-BNP (≥810 ng/l), the following will be characteristic: hypertensive history >12 years; the presence of signs of left ventricular hypertrophy on the ECG according to the Sokolov-Lyon criteria; increase in the right atrium >36 mm and systolic pressure in the pulmonary artery >38 mm Hg according to Echocardiography; an increase in the average daily heart rate >110 per 1 min with Holter ECG monitoring; a decrease in the glomerular filtration rate <56 ml/min/1.73m² and an increase in the total MLHFQ score >27. The dominant markers of a relatively high level of NTpro-BNP were a decrease in quality of life, instrumental signs of hemodynamic overload of the right heart and clinically significant cardiorenal disorders. With a relatively low serum level of NTpro-BNP (≤220 ng/l), the following will be characteristic: hypertensive history anamnesis <8 years; lack of signs of the left ventricle hypertrophy on the ECG according to the Sokolov-Lyon criteria; the size of the right atrium <34 mm and/or the value of systolic pressure in the pulmonary artery <33 mm Hg according to Echocardiography; average daily heart rate with Holter ECG monitoring <92 per 1 minute; glomerular filtration rate >68 ml/min/1.73m² and the total MLHFQ score <21. The dominant markers of a relatively low level of NTpro-BNP were the absence of signs of left ventricular hypertrophy on the ECG and a balanced state of sympatho-adrenal activity by the nature of circadian regulation of heart rate.

Keywords: atrial fibrillation; N-terminal fragment of brain natriuretic propeptide; clinical profile of patients.