Table 5.
Estimated clinical utility of adding NT-proBNP, BMP10, and ANGPT2 alone or in combination to a clinical risk score to predict sinus rhythm at 12 months
| Patients reclassified as high risk of not attaining sinus rhythm at 12 M (N) | Confusion matrix | ||||
|---|---|---|---|---|---|
| Predicted sinus rhythm (actual patients in SR: N = 1081) | Predicted: AF (actual patients in AF: N = 365) | ||||
| Patients in sinus rhythm at 12 M | Patients in AF at 12 M | Patients in AF at 12 M | Patients in sinus rhythm at 12 M | ||
| Clinical model (LA size > 50 mm, persistent AF, age > 75 years) | Reference | 813 (77%) | 245 (23%) | 75 (40%) | 112 (60%) |
| +NT-proBNP | 135 | 743 (79%) | 201 (21%) | 129 (40%) | 191 (60%) |
| +BMP10 | 240 | 670 (79%) | 175 (21%) | 161 (37%) | 279 (63%) |
| +ANGPT2 | 301 | 650 (82%) | 145 (18%) | 198 (40%) | 303 (60%) |
| +NT-proBNP and BMP10 | 298 | 638 (80%) | 158 (20%) | 183 (37%) | 315 (63%) |
| +NT-proBNP and ANGPT2 | 345 | 625 (83%) | 130 (17%) | 215 (39%) | 332 (61%) |
| +ANGPT2 and BMP10 | 410 | 570 (82%) | 125 (18%) | 223 (36%) | 394 (64%) |
| +NT-proBNP and BMP10 and ANGPT2 | 441 | 551 (83%) | 115 (17%) | 234 (36%) | 416 (64%) |
Sinus rhythm at 12 months was initially predicted by a clinical risk score based on three validated clinical features (LA size > 50 mm, persistent AF, age > 75 years) alone. This reference score was then combined with one, a combination of two, or all three binarized predictive biomarkers (biomarker thresholds: NT-proBNP < 1000 pg/mL or >1500 pg/mL, ANGPT2 < 3.5 ng/mL or >3.5 ng/mL, BMP10 < 2 ng/mL or >3 ng/mL, Table 4). If either the clinical risk score is ≥2 or any of the biomarkers added to the model surpasses its threshold, the model predicts failure to attain sinus rhythm at 12-month follow-up and predicts AF instead. All numbers indicate number of patients with percentages of the predicted class in brackets. There were 140 missing values in outcomes and 225 missing values in LA size. The additional use of biomarkers for prediction can lead to differing missing values in predictions made for participants with available outcome data.
AF, atrial fibrillation; ANGPT2, angiopoietin 2; BMP10, bone morphogenetic protein 10; NT-proBNP, N-terminal pro-B-type natriuretic peptide; SR, sinus rhythm; 12 M, 12-month follow-up.