Value of N-Terminal Pro-Brain Natriuretic Peptide for Embolic Events Risk Prediction in Patients with Atrial Fibrillation; a Systematic Review and Meta-Analysis

Introduction:

A comprehensive conclusion has yet to be made about the predictive value of serum N-terminalpro-brain natriuretic peptide (NT-proBNP) for stroke/systemic embolic events (SEE) in patients with atrial fib-rillation (AF). This study aims to review the evidence for evaluating the value of NT-proBNP in predicting the riskof stroke/SEE in patients with AF through a systematic review and meta-analysis.

Two independentreviewers screened all relevant studies that were retrieved from the database of Medline, Embase, Scopus, andWeb of Science until December 7th, 2021. The predictive value of NT-proBNP in the prediction of stroke/SEEwas recorded as hazard ratio (HR) and 95% confidence interval (95% CI).

Nine articles (38,093 patients,3.10% stroke/SEE) were included in our analysis. There was no publication bias in these studies (P=0.320). Ouranalysis showed that NT-proBNP can be a good predictor of stroke/SEE risk in AF patients, even at differentcut-off values (HR=1.76; 95% CI: 1.51, 2.02; P < 0.001). Subgroup analysis showed that diabetes could have apossible effect on the predictive value of NT-proBNP (meta-regression coefficient = 0.042; P = 0.037).Conclu-sion:Measurement of NT-proBNP during the first admission could be used to assess the short- or long-termrisk of stroke/SEE in patients with AF. Further studies are needed to evaluate the possible applicability of serumNT-proBNP measurement in the settings in which stroke is the sole outcome of the investigation.